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We are the Maternal Health Learning and Innovation Center, a network of maternal health equity experts and organizations working to make real change for women and birthing people in the U.S.
Our podcast is a series of episodes connecting around culture, lifting voices and stories, exploring innovations in maternal care and discussing ways we can center equity in the way we approach our health and wellness.
Learn more about us, explore our resource center and find support for all maternal health professionals at MaternalHealthLearning.org.
For more podcast information and content, visit MaternalHealthPodcast.org.
Kelli Sheppard - 00:00:03:
Welcome to the Maternal Health Innovation Podcast, Season 4. I'm your host, Kelli Sheppard, Communications Director at the Maternal Health Learning and Innovation Center. On this podcast, we listen to maternal health innovators about ways we can implement change to improve maternal health in the United States. Be sure you're subscribed. In today's episode, I'm talking with Victoria Pemberton, RNC, MS, CCRC, a project scientist with the National Heart, Lung, and Blood Institute, or NHLBI, about maternal heart health and the steps you can take to maintain a heart-healthy lifestyle throughout your pregnancy. We'll highlight populations most impacted by heart disease, factors like high blood pressure and stress that affect maternal heart health. And practical steps to protect your heart health before, during, and after pregnancy. Thank you for joining me, Vicky.
Victoria Pemberton - 00:01:10:
Thank you.
Kelli - 00:01:11:
I'm glad to have you on. I'm going to go ahead and get the conversation started. I have a few questions. The first, how is heart health related to maternal health and what do women need to know?
Victoria - 00:01:25:
Well, thanks, Kelli. I think it's a great question. I think there are three key points that women and their health care providers should understand about heart health. First, heart disease is the leading cause of death for women of all ages in the United States. And it is the leading cause of death during pregnancy and in the postpartum period as well. So it's really a big problem that we're looking at. Second, having a healthy heart is really important for women as they think about getting pregnant. As well as once they're pregnant and during the pregnancy. You know, sometimes we talk about pregnancy as a stress test. And it's a time indeed when the heart works harder than usual, pumping more blood to the mom and to the baby. So it's important for women to have good heart health habits as they consider pregnancy. So what do you do if you find yourself pregnant and you really haven't prepared? So even if someone doesn't have the best diet, or the most rigorous exercise routine, taking those steps early in pregnancy can really help. And we can talk a little bit more about that later. But the bottom line is to start adopting some heart-healthy habits as soon as you know you're pregnant. Or before pregnancy. And the final thing, women should know what might increase their risk for having a problem during pregnancy.
Kelli - 00:02:57:
Thank you. Can you also talk about important factors that can increase a woman's risk of heart disease before, during, and after pregnancy?
Victoria - 00:03:09:
Yeah, sure. Knowing your risk of developing heart disease is really critical. And although there are risk factors that we can't change about ourselves, like how old we are or our family history, There are many things we can control. And there's a whole list of those. Knowing having high blood pressure is a risk. High cholesterol or diabetes, being overweight or obese. Smoking or being regularly exposed to secondhand smoke is a risk factor. In addition, eating an unhealthy diet, not managing our stress. Where not getting enough physical activity or sleep can contribute to pregnancy complications. So the more these risk factors are under control before pregnancy, the more likely a woman is to have a healthy pregnancy.
Kelli - 00:04:04:
Can you tell us some of the most common pregnancy complications?
Victoria - 00:04:09:
Yeah, so I think there are four that we think about with respect to heart health. And the first one is high blood pressure during pregnancy. That could include women who come into pregnancy having hypertension. Just another word for high blood pressure. Or those who develop it during pregnancy. So preeclampsia is a type of high blood pressure that occurs only during pregnancy. It can range from mild to severe. And sometimes there are no signs of it at all, but signs to watch for our sudden weight gain over a very short period of time. We're talking days. Headaches or swelling in the hands or faith, just to name a few. The second is gestational diabetes. And this is, kind of what it sounds like. It's diabetes that occurs during gestation or pregnancy. And usually gestational diabetes, no symptoms again. But if not treated, it can increase your risk of having a miscarriage or a stillborn baby. If you have symptoms, they might be mild, like being more thirsty than usual or having to urinate more often. The third thing is preterm birth or a baby being born early. And this can happen spontaneously or as a result of delivering a baby purposefully early due to a pregnancy complication. So, for example, having severe preeclampsia can prompt an early delivery. And then the fourth complication are babies who are smaller in size than we would expect. And this could indicate that there might be a problem with the placenta and the ability of the baby to grow properly.
Kelli - 00:06:04:
While you were talking, it brought to mind my experience with my second pregnancy. I'm a little older having kids. So I was considered, there's a word for it, for basically you're an older mother. And I remember having to take so many tests at one point. And I'm bigger, so I had to see the doctor more often. So age, weight were a factor. I remember taking just basically taking more tests and having to do more with the midwife and the doctor because of those other factors you were just talking about, like the complications that could arise. So I appreciate you sharing.
Victoria - 00:06:51:
Your experience is really not so unique. There are a lot of women who do experience pregnancy complications. You know, certainly in some of the research that we do, we find that the ones that I just named are very common. But you also raised some risk factors, age, race, body size, perhaps hypertension or other things that can contribute. And we've talked a little bit about those already.
Kelli - 00:07:21:
Thank you, Vicki. What populations are most impacted by maternal heart health complications and why?
Victoria - 00:07:29:
Any woman can experience a pregnancy complication, but Black women, American Indian, and Alaska Native women as well as Hispanic or Latino women, all have higher risks for adverse pregnancy outcomes than White women. So let's start a little bit with what we know about Black women, and some of these statistics are pretty shocking. We know that African-American women are three times more likely to die from a pregnancy-related cause than White women. They have a higher risk of developing some conditions associated only with pregnancy, like we talked about gestational diabetes and preeclampsia. But I think what's really shocking the most, is that the Centers for Disease Control which is the CDC, estimates that more than 80% of Black maternal deaths are preventable. Now, with respect to American Indian or Alaskan Native women, they too are disproportionately impacted by pregnancy-related deaths. And most of these pregnancy-related deaths, 93% were determined to be preventable. And then we know that over a third of Hispanic or Latina women are living with cardiovascular disease. They're much more likely to have high blood pressure than their male counterparts and to be at an unhealthy weight. So why? Why are these groups at higher risk for pregnancy complications? Well, I think one of the causes is that many women may not be aware of their heart health risks. And I don't know about you going into pregnancy, but for instance, having a high sugar level or high cholesterol level or even high blood pressure. They may not produce any symptoms early on. So we may not even be aware that we have them. And pregnancy might be the first time since childhood that a young woman enters the Healthcare System. And she learns that she has high blood pressure or these abnormal blood levels. I think what's really impressive is that among Black women 20 years of age and older. And remember, this includes women in their reproductive years, nearly 59% have cardiovascular disease. And yet only half of them know that heart disease is their most significant health risk. So awareness is a key challenge. And I think the second thing is, while we know that obesity and stress, depression, and these underlying health conditions are key contributors, social factors are equally important. And these can include access to affordable and quality health care, particularly during pregnancy. And there may be issues stemming from structural racism, physical violence, or abuse during pregnancy, a lack of social supports, housing and food stability, we could go on. But there are social, factors that we do in the healthcare system need to consider.
Kelli - 00:10:47:
Can you share more about the nuMoM2b Heart Health Study and any information that is helpful for women to know about adverse pregnancy outcomes?
Victoria - 00:10:59:
Oh, I'd be delighted to share more about that. Several years ago, about 10,000 women who were pregnant with their very first babies, were enrolled in a study designed to find out more about pregnancy complications. So we could learn more about what these complications were and how often they occurred. The nuMoM2b Heart Health Study which is funded by NHLBI. You mentioned the National Heart, Lung, and Blood Institute earlier, which is a division of the National Institutes of Health. That study is now following these women to better understand whether having a pregnancy complication increases your chances of having cardiovascular disease later in life. And indeed, results from some of those studies have shown that women who have a pregnancy complication are more likely to have high blood pressure within two to seven years after pregnancy. This is pretty surprising. I mean, two years is a very short period of time after you deliver your first baby. We also know that women with pregnancy complications have risk factors. Like high blood pressure, abnormal glucose obesity. So it's the same things that put a woman at risk for later heart disease. We also know that women with preeclampsia, remember that special type of high blood pressure we talked about. Have an increased risk of having blood clots and strokes later in life. And women with gestational diabetes have an increased risk to get Type 2 diabetes. What we've learned is that It appears that having conditions prior to pregnancy, contribute to pregnancy complications. And that pregnancy complications contribute to the future risks of heart disease. And while this is a little bit concerning, it also offers us multiple opportunities along the way to address maternal health in the time before pregnancy, as well as during and then after pregnancy. And while we're talking about knowing your risks, I wanted to mention that a new calculator, a risk calculator, was developed called Prevent. And this estimates a person's risk of getting heart disease within the next 10 years and also 30 years. Dr. Sadia Khan, who is an investigator with the nuMoM2b Heart Health Study and her colleagues from the American Heart Association recently published on this tool. And I think what makes it really unique is that it can assess individuals according to gender as young as 30 years of age. All of the other risk calculators really used age as a big factor. And so since this is the population we're concerned about, this could make it a very valuable risk calculator. Now, I will say that It does require a significant number of lab results. So would only be useful for those individuals who have recently had blood work. But pregnant women who are 30 years of age or older and their caregivers could find it very useful. I mean, pregnancy is obviously a time when a lot of blood is taken. You know that yourself.
Kelli - 00:14:40:
Yes. Yes. I appreciate that information, Vicki, and sharing that new calculator. What healthy lifestyle changes can women make to help improve their heart health before, during, and after pregnancy?
Victoria - 00:14:58:
Well, that's a loaded question. We've talked a little bit about some of those things. But if you're pregnant or planning a pregnancy, I think it's really important to take steps to make sure you have a heart-healthy pregnancy. It's not only important for you, but the health of your baby. And we're learning that more and more, that a mom's health is reflected in her baby's health as well. The American Heart Association has developed something called Life's Essential 8. And these are eight things that we should do, all of us, to be heart healthy, whether we're experiencing pregnancy or not. And so I'd love to just go through those with you quickly and give some information about each one of them. So the first one is physical activity. And as we're all sitting here, talking. Underneath my desk, I do have a little a little exerciser so I keep my feet going. Physical activity is really important for all of us. But an interesting finding came out of the nuMoM2b Heart Health Study, which addressed physical activity during pregnancy. And this study showed that women who had very low levels of physical activity across their pregnancies had higher risks of gestational diabetes and preterm birth compared to women who had higher levels. But what was even more interesting is that women who started out in that low group, but increased over time had low rates of gestational diabetes like the women who had the higher patterns. So increasing activity, and it seems even by just a little and not a lot, might be associated with improved pregnancy health. The second thing is managing your blood pressure. We've talked a lot about blood pressure and knowing your numbers, asking if you should monitor your blood pressure at home and then learning how to do that. But in a recent clinical trial called CHAP. CHAP stands for Chronic Hypertension and Pregnancy). Pregnant women who had mild chronic hypertension were treated with medications. And the goal was to get their blood pressures to less than 140 over 90. And when those blood pressures were achieved, a woman had better pregnancy outcomes compared to women who received only treatment for more severe hypertension. And the study found that there was no increased risk of having a smaller for gestational age baby. So learn your numbers. Number three, this is a no brainer, stop smoking. Again, results from the nuMoM2b Heart Health Study showed that women who smoked during pregnancy were more likely to have high blood pressure and abnormal cholesterol levels. So that's a warning sign. Your body is telling you something. Number four is sleep. We don't always think about sleep. But pregnancy is a time when women, maybe don't sleep as well as they used to. Or they begin snoring or have sleep apnea because of the way that babies are positioned. So again, the study, the nuMoM2b Heart Health Study, showed that women with increased sleep apnea during pregnancy had higher risks of developing metabolic syndrome. Now, metabolic syndrome is a cluster of five things that could lead to heart disease or diabetes, stroke, other health problems. It's diagnosed when a person has three or more risk factors. This won't come as a surprise. High blood pressure, high blood sugar, high levels of triglycerides in your blood, large waist circumference, and low levels of good cholesterol in your blood. So if you have three or more of those, you would be diagnosed with metabolic syndrome and the chances of developing a serious cardiovascular condition increases significantly. So five and six are just about kind of those same things. Know your numbers for your cholesterol and your glucose. And talk with your healthcare providers about tips how to manage these conditions through again, diet, exercise, stress reduction, better sleep, and medications. Number seven is diet or heart-healthy eating. NHLBI has funded research on this area and has a healthy eating plan called DASH. DASH stands for Dietary Approaches to Stop Hypertension. And DASH is a flexible, balanced eating plan. Can help you eat heart-healthy for Life requires no special foods. But rather gives you daily and weekly nutritional goals. And research has shown that DASH, can lower two major risk factors for heart disease, high blood pressure and high cholesterol. So the last of Life's Essential 8 is weight management. So being overweight or having obesity prior to pregnancy or very early in pregnancy can increase your risk of having pre-eclampsia or diabetes. Now, a key concern for clinicians is that many women fail to lose their pregnancy weight. And then subsequent pregnancies are at even higher risk. So diet and exercise plans are ideal. But they may not be adequate to address the excessive weight gain or weight retention that we as women have after pregnancies. This may mean also assessing an individual's social condition. To better understand food stability and access and neighborhood walkability and other things that contribute to weight management.
Kelli - 00:21:34:
That I'm thinking so many things, Vicki. But, just to speak from my own experience. So remember I told you I was going to the doctor like almost every week, blah, blah, blah, blah, blah, right? And after I delivered, those doctor appointments. Slowed all the way down for me, you know, and everything was focused on the baby, right? And I think that it's the after pregnancy health care that could use a lot of improvement in our health care system overall. Things that you just talked about, like the DASH diet, for example, if I had known about that years ago, my daughter will be five in August. But I think that if I had known about that years ago, then maybe I wouldn't have found out last year that I have high cholesterol. Or if maybe I had access to a nutritionist that didn't cost an arm and a leg. Then maybe I would have known that because I was sleep deprived, I was craving more sugar. And what could I do and things that I could do to fix issues like that, find ways to get more sleep, for example. You know, I didn't learn all this until maybe the last year or so after getting that high cholesterol diagnosis. So, I'm going to pivot. We want to learn more, of course, about the Heart Truth. How can our listeners learn more about The Heart Truth Program? And are there any resources you'd like to share?
Victoria - 00:23:20:
Well, I think there are a lot of good resources that we could share and you just you know, talked a lot about some things that you wished you had known. And so there are resources in The Heart Truth Program that NHLBI sponsors. This is an educational program. It has a variety of science-based educational materials and information. And a lot of these can be downloaded or they can be ordered free of charge as hard copies. But there are a couple that I think are really pertinent to our discussion today, pregnancy and your heart health is one fact sheet that provides information on the risks of high blood pressure before, during, and after pregnancy. And it covers topics like preeclampsia and gestational diabetes and risk factors. So this is available for caregivers to hand out to their They're their families and to their clients as well as for patients themselves. A second one is the high-blood pressure and women fact sheet. And this covers exactly what it says. Risk factors again. Tips for checking your blood pressure, and there is also pregnancy-related information there. There is a link to the DASH eating plan. And that has guidance on how to follow the eating plan, but also recipes. That are heart healthy if you're an adventurous cook. And then stress less for healthier heart. I think we don't give enough credit to stress for how damaging it can be. Remember, we've talked about pregnancy as being the ultimate stress test for women. But when we experience stress, our heart rates go up, our breathing increases, our blood vessels narrow, and this restricts blood flow. And this can trigger a cardiovascular event or increase your blood pressure. So although we know we can't always avoid stress, we can change how we respond to it by using relaxation techniques, meditation, yoga or by talking with trusted friends and family. Being more physically active. A lot of people find that physical activity helps them manage stress. So there's a fact sheet there that will give you a little bit more information. And then you touched on something about self-care. It's really true that often for women, we put our children, our family members, everyone else ahead of us. And so it's really important for us to take care of ourselves, to make heart health part of our daily routine. You know, research shows that self-care can help you keep your blood pressure in a healthy range and reduce your risks. But practicing this every day, taking small steps like, maybe adding a little more physical activity to your day, parking a little further at the Shopping Mall or to the grocery store, adding an extra fruit or veggie to your meal. Taking some time to just breathe and de-stress during your day and getting enough sleep. I know that's a tall order for a lot of busy moms, but in much of the work that the nuMoM2b Heart Health Study has done, It's very clear that being heart healthy before pregnancy is a key factor. In pregnancy outcomes. So caring for yourself and preparing for pregnancy is really beneficial. And we mentioned this not only to mom, but to baby too. So, um, our visitors or our viewers today can visit the www.hearttruth.gov website. And there they'll find these fact sheets and more resources and tips. And you can also follow The Heart Truth on social media. And I think all of those will be. Provided also in the show notes.
Kelli - 00:27:51:
Thank you, Vicki, for taking the time to join us today. And thank you for listening. For more podcasts, videos, blogs, and maternal health content, visit the Maternal Health Learning and Innovation Center website, maternalhealthlearning.org. We do want to hear from you. Tell us what you want to hear more of. Leave a review of our podcast and share our podcast with other like-minded innovators. We've got some great episodes recording now. Be sure you are subscribed. Let's keep talking. Tag us in your posts using #MaternalHealthInnovation. I'm Kelli Sheppard, and we'll talk to you again soon on the Maternal Health Innovation Podcast.
Kelli - 00:28:39:
This project is supported by the Health Resources and Services Administration, HRSA, of the U.S. Department of Health and Human Services, HHS, under grant number U7-CMC-33636, State Maternal Health Innovation Support and Implementation Program Cooperative Agreement. This information or content and conclusions are those of the author and should not be construed as the official position or policy, nor should any endorsements be inferred by HRSA, HHS, or the US government.