Better Maternal Health Starts with the Heart

We are more aware today than ever that heart disease is the leading cause of death among both men and women in the U.S. However, research shows that women actually tend to be more anxious about getting breast cancer—even though heart disease kills as many as six times more women annually. What’s even more alarming is the recent trend showing that increasing numbers of young women are becoming victims of heart attacks and heart disease.

With more women in child-bearing years today at greater risk of heart-related problems, it’s critically important to get a solid understanding of conditions linked to women’s heart health as well as those that can affect pregnancy.

Cardiovascular disease is now the leading cause of maternal death during pregnancy, attributable to 26.5% of pregnancy-related deaths, according to the American College of Obstetrics and Gynecologists (ACOG). Furthermore, women of color often have the highest mortality rates, with black women who deliver in the U.S. three to four times more likely to suffer a pregnancy-related death than white women.

Differences between men’s and women’s heart risks

There are a wide range of disparities between heart disease/heart attack symptoms in women and men. Studies have shown that women:

  • Rarely feel the crushing chest pain that men frequently do during a heart attack. Instead, women who have had a heart attack describe feeling pressure or tightness rather than sharp pain. As a result, women often dismiss these episodes, not realizing that they need treatment immediately.
  • Have smaller coronary arteries than men do, making angioplasty and coronary bypass surgery more difficult to do—and reducing a woman's chances for a better outcome.
  • Who have diabetes are at higher risk of heart disease than men with diabetes. For women who have already had a heart attack, diabetes significantly increases the risk for another heart attack and heart failure.

Accordingly, heart care for women involves different approaches than those for men and a thorough knowledge of personal health history and pre-existing conditions for optimal heart health.

Preconception heart care

Women’s hearts naturally take on a greater workload during pregnancy as the need for greater blood volume and an increased heart rate adds additional strain. It’s important to optimize heart health even before conception to avoid or reduce the risk of heart-related complications with a pregnancy. In addition to consultation with your physician/OB‑GYN, women who are preparing for pregnancy should:


Women who have conditions such as obesity, diabetes, high blood pressure, or familial hypercholesterolemia (an inherited condition that keeps cholesterol levels high) are at higher risk overall for pregnancy complications. These can include preeclampsia, a dangerous condition that can strike after 20 weeks of a pregnancy and is caused by the lack of development or normal function of newly formed blood vessels to the placenta. Symptoms include:

  • Excess protein in urine
  • Nausea and/or vomiting
  • Changes in vision, including blurred or loss of vision
  • Abdominal pain on the right side
  • Lower levels of blood platelets
  • Severe headaches

Preeclampsia can harm the placenta and the mother's kidneys, liver, and even brain. Black women are also at higher risk of developing the condition than women of other races. While there are no clear-cut ways to prevent preeclampsia, some women can help reduce the risk though low-dose aspirin or calcium supplements. As always, talk to your physician to better understand your risk.

Late pregnancy/postpartum

There are also a number of symptoms related to heart disease that need to be carefully monitored during late pregnancy and the 5 months following childbirth. These include:

  • Extreme fatigue
  • Unusual weight gain or swelling
  • Fast heart beat
  • Shortness of breath, especially when lying down
  • Dizziness or fainting

If you experience any of these symptoms and they do not subside, be sure to contact your OB/GYN or primary care physician as soon as possible. If you experience extreme pain or shortness of breath, have someone take you to the ER or call 911.

When you’re anticipating a pregnancy or are pregnant, be vigilant about monitoring any unusual conditions related to your heart health. There are many other aspects related to the health of you and your baby that will be on your mind, but don’t forget to prioritize your heart as well. Even if you aren’t pregnant, it’s always smart to maintain routine visits with your doctor to monitor your heart health and overall wellbeing.

Elizabeth Ofili, M.D., MPH, FACC

Elizabeth Ofili, M.D., MPH, FACC.

Specializes in Cardiology, Internal Medicine

Dr. Ofili is a Professor of Medicine and Director of the Clinical Research Center at Morehouse School of Medicine.

Learn more about Dr. Ofili.