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  • Sonali Quantius

The cost of bringing a child into this world (Part 2)

Volume 6, December 2018, Pages 82–88

I received feedback that the first part of this series was too complicated and I should make it simpler. Sometimes I forget that I am not writing a scientific paper. So, in the subsequent blog posts, I will challenge myself to write clearly, without scientific jargon! This is my first attempt (and I promise I will get better with time). So here goes:

A woman carries a baby for 38–40 weeks. No big deal. It represents 0.009% of her lifetime.

What IS a big deal, however, is what happens to her body in the short and long term and the consequences it presents for the rest of her life. In this post, I will show what happens to her heart:

When men (and women sometimes) reach a certain age, they are invited to a doctor’s office and are hooked to some wires while asked to walk increasingly fast on a treadmill to see how your heart is coping. In medical terms, it is called a ‘cardiac stress test’ since you are ‘stressing’ the heart to see if your heart can pump blood as fast and as effectively as you need it to, and if there is a blockage somewhere that prevents the blood from reaching the heart or other organs. That is, is there a mismatch between supply and demand of blood flow in response to higher demands on the heart?

Usually, when we imagine such a scene, a middle-aged/older man comes to our mind but the fact is, a woman goes through a cardiac stress test naturally each time she is pregnant.

Pregnancy is the first cardiac stress in a natural setting.

Here are the things that happen to a woman’s heart when she is pregnant: her heart rate increases by 10 to 15 beats per minute, the amount of blood pumped out by the heart increases by 30–40% per minute, her blood pressure decreases and the amount of blood in her body increases by 40–50%. Her heart has to work much harder and her cardiac system needs to increase output and efficiency by 50% when she is pregnant. Add 20% more if she is carrying twins.

In fact, I read that the difference in cardiac (heart) performance between trained athletes and couch potatoes disappears during pregnancy. And that: a normal pregnancy is an equivalent, in cardiac output and ventilatory volume, of a 10,000 km (6,213 miles) walk! The human body never stops to amaze me but it is remarkable to see how the body adapts to the metabolic demand of pregnancy.

The question is: does the heart get back to functioning normally after the woman is no longer pregnant and there is no more metabolic demand on her body? Well, in most cases, it does.

But- if she had pre-existing heart conditions before, then this can increase her risk of making it worse. And the reverse is true: if there were complications during pregnancy, this can lead to an increase in the risk of heart disease later on. Jen Rohe, a 33-year-old woman went from delivering a healthy baby girl to being diagnosed with heart failure and getting a heart transplant in the span of just 50 days — read her incredible story here. She was diagnosed with peripartum cardiomyopathy, a type of heart failure that is difficult to detect because symptoms are similar to normal postpartum symptoms. According to the article, Rohe is sharing her experience as part of the American Heart Association (AHA) Go Red for Women movement’s “Real Women” campaign to spread awareness that new moms like her need to be aware of the risk of heart disease. These are all the things that can go wrong with your heart while being pregnant:

In the United States, cardiovascular disease is the leading cause of maternal death and is responsible for >33% of pregnancy-related deaths including cardiomyopathy (11%), other cardiovascular conditions (15.7%), and cerebrovascular accidents (7.7%). It is estimated that 68% of these deaths are preventable.

This is not to say that no one should become pregnant — quite the opposite. However, as in everything in life — knowledge is power. Understanding the risks that place more stress on the heart than it already has due to pregnancy can go a long way in preventing these complications. Evaluating every pregnant woman carefully for her heart function, especially those with higher risk or with previous heart conditions, and close postpartum follow-up with coordinated health care delivery between cardiologists and obstetricians, especially for high-risk women can prevent the majority of these deaths.

I always knew that my children have touched my heart deeply — I just didn't know just how literally!

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