Cardiovascular disease is associated with high pregnancy mortality. Most of them can be prevented

 

The chest pain started early in Ashley LaSerra’s second pregnancy. At 12 weeks she felt the way she did at 30 weeks with her first child.

Like all her life, she went to her cardiologist: “I told him:“ I don’t feel well. Is there something wrong.'”

LaSerra was born with a ventricular aneurysm, a tumor in the wall of her heart’s lower pumping chambers. When her heart beats, the tumor swells like a water balloon; if it bursts, she may die. Her pregnancy exacerbates this risk.

Under the supervision of medical professionals from the health networks, LaSerra and her daughters, who were born 18 months apart, survived.

Many women don’t: CVD is the leading cause of maternal death during or within a year of pregnancy. Nearly 70 percent of these deaths are preventable, according to a 2018 report by the Nine Maternal Death Review Committees.

Levels of protection, like the team approach that LaSerra got, can help.

“You really feel with this group, ‘Hey, I can live nine months with a safe pregnancy,'” she said.

During pregnancy, the heart works in two shifts, pumping more and more blood to feed not one, but two organs. During pregnancy, the blood supply increases by 30-50%.

“Pregnancy is a nine-month stress test for the heart,” says Dr. Ayanna Anderson, a gynecologist in Fort Worth. “If you already have heart problems, you’re putting more stress on something that isn’t in the best shape yet.”

Heart disease, under the umbrella of cardiovascular disease, can be acquired or congenital, meaning that the problem is present from birth. In the United States, the most common form of heart disease is coronary artery disease, which develops over time and restricts blood flow to the heart.

However, during pregnancy, the story changes. Congenital heart defects such as LaSerra aneurysm are the most common. According to the Cleveland Clinic, cardiomyopathy, a disease of the heart muscle that can be congenital or acquired, causes the most serious problems.

There are many consequences. Heart disease during pregnancy can lead to high blood pressure, including preeclampsia, which can lead to seizures; Diabetes mellitus during pregnancy; irregular heartbeat, which can cause blood clots, which can lead to stroke and heart attack.

At LaSerra’s physical exam a year ago, her heartbeat seemed abnormal. An echocardiogram revealed an aneurysm.

Over the next nearly thirty years, he experimented with various examinations and treatments: heart rate monitors, MRIs, echocardiograms. At 16, she began taking beta-blockers, drugs to lower her blood pressure. When she was 18, her cardiologist told her that she would never have children. “She could understand a lot for an 18-year-old teenager,” Lacerra said.

Years have passed. Lacerra married her high school sweetheart, who supported her when she received bad news from a cardiologist. When they moved to Fort Worth in 2016, LaSerra asked Dr. Scott Pilgrim, a pediatric cardiologist at Cook Children’s Medical Center, for a second opinion.

Pilgrim runs the adult congenital heart disease program at Cook’s Children’s Hospital, a lesser-known part of the Children’s Hospital trappings. Some of her patients, she told LaSerra, are in their 80s.

His specialty, adult congenital heart disease, has evolved with advances in treatment. In the past, children born with heart disease did not survive into infancy. As medical care and treatment improves, more than nine out of 10 children born with mild heart defects and about seven out of 10 children with serious heart defects survive to 18 years of age.

Most of these children may have children of their own, Pilgrim told the Fort Worth Report.

“There’s really no reason why most congenital heart disease patients can’t have children,” Pilgrim said. “Most of them can actually have safe and successful pregnancies with proper supervision and care.”

For her pregnant patients, Pilgrim collaborates with Maternal and Fetal Medicine of Texas, a team of fetal and maternal medicine physicians, including Anderson, from Texas Health Resources. Pilgrim gave LaSerra the green light.

“It was like, ‘Here’s a group of people who will follow you if you do this,’” LaSerra recalls. “When you’re ready, move forward.”

Each month, the Cook Children’s and Texas Health Fort Worth healthcare provider team meets to discuss common patients.

For each patient, the team considers whether problems occurred during the pregnancy, which delivery is more appropriate, vaginal delivery or caesarean section, what type of cardiac monitoring the patient may need, what postpartum care may be, among other issues. By the end of the meeting, the team has an updated delivery plan.

“(Suppliers) always knew what was going on with each other,” LaSerra said. “They would all touch each other and hit the same page.”

In 2018, both the American Heart Association and the American College of Obstetricians and Gynecologists recommended “increased collaboration” between cardiologists and OB/GYNs to address gaps in care.

That same year, the European Society of Cardiology described something even more concrete: the use of multidisciplinary cardiac teams during pregnancy to reduce mortality before, during, and after childbirth.

The care model can only do so much. Pilgrim is concerned that patients who are at risk of heart complications during pregnancy do not receive the care they need before pregnancy. Between 30 and 50 percent of children with heart disease stop receiving heart care before they reach adulthood, she said.

“I’m afraid there are hundreds, if not thousands, of adults in the Fort Worth area who had heart problems as children and are not being monitored,” he said.

Elsewhere in Fort Worth, a dedicated multidisciplinary sales team is working to welcome people into their own homes.

Healthy Start offers home health visits for women and families before, during and after pregnancy. The program, funded by the government and operated by the University of North Texas Health Sciences Center, was launched in 2014 to help reduce the infant mortality rate in Tarrant County.

Tanya Lopez, Nurse Midwife at Healthy Start, calls the program “another level of surveillance.”

Historically, Tarrant County’s rate has been among the highest in Texas and also higher than the national average. Most children who do not live past the first year of life die from congenital malformations, the most common of which is related to the heart.

The health of the baby’s heart is inextricably linked to the health of the mother’s heart. For most people, the risk of having a child with a congenital heart defect is about 1%. The risk increases to at least 3% for parents with congenital heart disease, according to the 2020 Cold Spring Harbor Perspectives in Biology review.

When Lopez meets with patients, she tells them to look for signs of heart problems: severe shortness of breath, heart palpitations, chest pain or pressure, coughing when lying down. Basically she is categorical: find out your history and the history of your family and ask questions about your condition.

During both pregnancies, LaSerra kept a pulse oximeter handy, which measures blood oxygen levels, a blood pressure cuff, and a notepad. When questions arose, she wrote them down. At the next monthly medical team meeting, she asked them.

The chest pain she felt at the start of her second daughter’s pregnancy eased when Pilgrim increased her dose of beta-blockers. Both deliveries – by caesarean section – were regular, and over the next 24 hours, LaSerra’s paramedics monitored his heart for any interruptions. She and her daughters were later released.

LaSerra herself works as a nurse. She now works with the Pregnancy Core Team at Texas Health Fort Worth. She is ready to tell her patients her story about her.

None of her daughters were born with a heart defect. Maybe someday she and her husband will try another one.

“Don’t let anyone tell you no,” she said. “We have wonderful doctors who are paving the way for you. Maybe. I was told no at 18 and now I can say I did it twice. We have doctors, good technology and resources in Fort Worth.

Alexis Ellison is a health reporter for the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via tweet. At Fort Worth Report, news decisions are made independently of board members and financial backers. Read more about our editorial independence policy here.

Content and Photo credit go to Texas Standard

This article first appeared on Texas Standard News

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