Diabetes, hypertension, hypercholesterolemia, obesity, sedentary lifestyle, smoking … The increasing prevalence of cardiovascular risk factors in recent years has increased the number of pregnant women at risk of heart disease. During pregnancy, the woman is protected and cared for to guarantee her health, but what happens next? "It seems that with the delivery everything ends, but the woman who has diabetes or another cardiovascular problem continues to need control as important or more than during pregnancy," said Manuel Anguita, president of the Spanish Society of Cardiology (SEC).
In addition, although the woman has not previously presented cardiovascular risk factors, these can develop during pregnancy and remain after the end of it, with repercussions on health throughout life. On the occasion of International Women's Day, which is celebrated on March 8, the SEC, together with the Spanish Societies of Primary Care Physicians (SEMERGEN), Family and Community Medicine (semFYC), Gynecology and Obstetrics (SEGO), Endocrinology and Nutrition (SEEN), Diabetes (SED) and for the Study of Obesity (SEEDO-SEO), have presented this Wednesday at the Casa del Corazón the project Vascular risk from the 4th quarter, with the aim of raising awareness about the need to control the risk factors for the heart once the pregnancy is over.
9.2% of women develop gestational diabetes, and between 6% and 8% suffer hypertensive disorders during pregnancy. These pathologies, together with preeclampsia and eclampsia (increased blood pressure with liver and kidney damage that can lead to seizures) or preterm delivery can affect the heart of women, too, after delivery. "Pregnancy is a test of physiological effort for any woman, in which hypertrophy occurs in the heart to carry the burden of having a life in. This means that some genetically prone women can develop cardiovascular problems during this period, which they can continue later, "said Almudena Castro, cardiologist at the La Paz University Hospital (Madrid) and coordinator of the SEC's Diabetes and Obesity Working Group.
In turn, patients with early gestational loss also enter this risk group that occurs in the, called in the project, fourth quarter. "Especially those who have had recurrent abortions, that is, three or more." According to a recent study that includes nearly one million women followed for 35 years, spontaneous preterm delivery is an independent risk factor, which may include an increase of ischemic disease, heart attack or stroke ", explained María Goya, an obstetrician at the Vall d'Hebron Hospital in Barcelona, and secretary of the Spanish Group on Diabetes and Pregnancy of SEGO.
Lack of follow-up after delivery
Despite these data, 75% of women who have developed complications during pregnancy do not undergo medical monitoring once they have finished. "The problem is that women believe that once they have given birth to their children, the problem is over and both the professionals are no longer aware that this is a risk factor associated with these women, as they forget that they have an risk and not take care as they should, "Castro added.
To avoid the lack of follow-up after childbirth and reduce risk factors, experts have pointed out a number of points that they consider key: promoting the figure of personalized midwives; Maintain breastfeeding for at least six months; perform a family approach to healthy life habits, which includes following a varied and balanced diet; practice moderate intensity physical exercise on a regular basis; give up tobacco; plan postpartum contraception, delaying a future pregnancy until weight is controlled; establish medical examinations in companies as fundamental to screening; and add these patients as a risk group in the different clinical practice guidelines.
"Traditionally, there is no follow-up protocol, even if there has been some problem during pregnancy.After childbirth, all efforts go to the baby and mothers move to a second place in terms of health care", she said. highlighted Vicente Pallarés, coordinator of the Working Group on Arterial Hypertension and Cardiovascular Disease of Semergen. Meanwhile, Irene Breton, also present in the presentation, stressed that, among other risks, "one in two women with gestational diabetes may develop type 2 diabetes within 5 to 10 years." Therefore, "after delivery, it is necessary to continue monitoring, maintain a healthy lifestyle and control weight, something that is not always carried out."