Heart to Heart - When heart conditions affect pregnancy and beyond

Ashley Payne was a college student at the University of Kentucky when she learned she had high blood pressure, or hypertension, during a regular checkup.

“It was a big shocker — I wasn’t the typical picture of high blood pressure,” said Payne, who was not overweight and ate a healthy diet.

For 10 years, she took blood pressure medicine that kept her condition under control. But that changed when she got pregnant with her first child. She was the most fit she’d ever been, but despite changing medications her blood pressure continued to rise.

“My blood pressure was going up, up, up,” Payne said. “It spiraled out of control.”

The answer wasn’t as easy as continuing to try different medications, since many blood pressure medicines are not safe, or have not been tested for safety, during pregnancy.

Pregnancy was stressing Payne’s heart and circulatory system. Her blood volume and heart rate were increasing to nourish the growing baby — changes that cause the heart to work harder.

“High blood pressure is a common complication of pregnancy,” said Janet L. Smith, M.D., cardiologist and director of Norton Women’s Heart & Vascular Center.

The problem can occur in women who had high blood pressure before pregnancy or have never had high blood pressure. Women who experience the latter, called gestational hypertension, return to normal blood pressure levels within several weeks after giving birth.

High blood pressure is important to diagnose and treat during pregnancy because it poses serious risks to mother and baby. Those include decreased blood flow to the placenta, which reduces the baby’s supply of oxygen and nutrients; placental abruption, in which the placenta prematurely separates from the uterus, depriving the baby of oxygen and causing heavy bleeding in the mother; and premature delivery.

“Recently, it has been recognized that pregnancy may also give some insights into risk of future heart disease,” Dr. Smith said. “High blood pressure is one of several pregnancy complications that results in women having increased risk for heart disease.”

Dr. Smith said that identifying these women and educating them can decrease their chance of developing heart disease later. Women who deliver at Norton Healthcare facilities are screened for pregnancy complications, including high blood pressure.

“We can then offer classes and resources to the new moms who have these complications to give them tools to reduce their heart disease risk,” Dr. Smith said.

During her pregnancy, Payne’s high blood pressure turned into a condition called pre-eclampsia.

“If she had not delivered early, her life and that of her baby would have been in even more jeopardy,” Dr. Smith said. “When pre-eclampsia occurs, delivery is the only cure. Complications including seizures, stroke, liver abnormalities and clotting problems can occur.”

Payne checked her blood pressure daily while she was pregnant. Although she was never placed on bed rest, her activity was restricted. Five days before delivery, her blood pressure skyrocketed and she was admitted to the hospital.

In February 2012, at 26 weeks, Payne gave birth to her daughter, Palmer, who weighed just 1 pound, 10 ounces. Today Palmer is a healthy toddler, and, with the help of a different medication, Payne’s blood pressure is back to normal.

“Even though high blood pressure and related disorders during pregnancy can be serious, most women with high blood pressure have successful pregnancies,” Dr. Smith said. “Getting early and regular prenatal care is the most important thing you can do for you and your baby.”

–Stephanie Doyle

About our physician
Janet L. Smith, M.D., practices at Norton Cardiovascular Associates – The Springs, The Springs Medical Center, Suite 200, 6420 Dutchmans Parkway, Louisville, KY 40205; (502) 891-8300


Come to Heartstrings, a free class just for new moms on how to live heart-healthy. A Norton Healthcare dietitian and an exercise physiologist will discuss tips for eating healthy and exercising.

Heartstrings
Tuesday, Feb. 18
11 to 12:30 p.m.
Marshall Women's Health & Education Center
Register now.