New mother holding their baby

Postpartum heart health risks

Nature’s cardiac stress test – how new mums need to be mindful of the fourth trimester

7 August 2023

Leading cardiologist Professor Jason Kovacic from the Victor Chang Cardiac Research Institute is calling for more awareness of the heart health risks associated with the weeks and months after giving birth.

Whilst diseases such as diabetes and pre-eclampsia are monitored for during pregnancy, there is now growing awareness of the possibility of developing cardiovascular disease in the year post-birth.

These diseases include peripartum cardiomyopathy, spontaneous coronary artery dissection (SCAD), and postpartum pre-eclampsia.

Professor Kovacic, Executive Director of the Victor Chang Cardiac Research Institute, said that although maternal deaths following pregnancy in Australia are very rare, it is still important to note that cardiovascular diseases are the leading cause of death during pregnancy and also the most common cause of death during birth and the seven weeks after.

“Pregnancy is called nature’s cardiac stress test for a very good reason. When you are pregnant the body experiences around a 50 percent increase in blood volume which means the heart must work a lot harder. This and other factors can stress the heart or blood vessels and lead to the development of conditions such as pre-eclampsia, gestational diabetes, or even premature birth.

“Most women and doctors are on the lookout for these conditions, but we need to keep a far closer eye on the mother in the critical weeks and months after giving birth, where very rare but serious complications and diseases can also occur. We really need to stop thinking of pregnancy as just three trimesters, because the fourth can be equally critical.”

Such complications include SCAD; a rare but serious heart condition that results when an inner layer of one of the blood vessels in the heart tears. It’s the most common cause of a heart attack during pregnancy or just after giving birth.

Another condition to be aware of is peripartum cardiomyopathy (PPCM) which causes weakening and enlargement of the heart muscle that affects the ability of the heart to pump blood around the body. In very severe cases it can lead to heart failure. PPCM most commonly occurs in the last month of pregnancy and in the five months post-birth.

Postpartum pre-eclampsia also develops after birth and can lead to dangerously high blood pressure. It can affect women who did not experience pre-eclampsia during their pregnancy, and who have never had high blood pressure. Although postpartum pre-eclampsia can lead to strokes, seizures and other complications, if it is correctly diagnosed and treated the prognosis is generally very good.

“Heart problems can affect even the most healthy mum, but research has shown that those over the age of 35 are more likely to have heart-related issues than younger parents.

Being overweight or having existing high blood pressure can also raise your risk,” said Professor Kovacic.

Professor Kovacic says it’s vital that both the medical community and new parents are aware of the increased risk of heart disease and take note if there are any warning signs.

“New parents are bound to be stressed and over-tired, but if you have any unusual symptoms don’t be afraid to seek help immediately and if you have follow-up appointments after giving birth you should keep them. Whilst it’s a busy time, it’s important to keep an eye on your heart health too,” he said.

Symptoms of PPCM include fatigue, shortness of breath, low blood pressure, and swelling in the legs and abdomen. Signs of a SCAD attack may vary from mild discomfort in the chest to common heart attack symptoms, whilst signs of postpartum pre-eclampsia can be headaches, blurred vision, and nausea.

The Institute is undertaking world-leading research into the causes SCAD which primarily affects fit and healthy women.

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Ursula and her family

“I’ve also been told I could be at risk of having another SCAD if I have another pregnancy. We spoke with a few specialists who could not provide any definitive statistics or risks.“

- Ursula Bouzaid, SCAD patient

Acknowledgement of Country

The Victor Chang Cardiac Research Institute acknowledges Traditional Owners of Country throughout Australia and recognises the continuing connection to lands, waters and communities. We pay our respect to Aboriginal and Torres Strait Islander cultures; and to Elders past and present.

Victor Chang Cardiac Research Institute - The Home of Heart Research for 30 Years