American Heart Month | From the Desk of Maddy the Doula Lady
The Heart of Birth: What Every Pregnant Person Needs to Know About Cardiovascular Health
February is American Heart Month — and while most heart health campaigns focus on heart attacks and cholesterol, there's a crucial connection that doesn't get enough attention: the link between pregnancy, heart health, and maternal mortality.
Here's something that might surprise you: cardiovascular conditions are the leading cause of pregnancy-related death in the United States. Not hemorrhage. Not infection. Heart problems.
And here's what makes it even more important: many of these deaths are preventable. With awareness, early detection, and proper care, we can change these outcomes.
This American Heart Month, let's talk about what your heart goes through during pregnancy, the warning signs everyone should know, and why cardiovascular health is a maternal health issue.
The Numbers That Should Wake Us Up
Cardiovascular disease during pregnancy isn't rare — it's increasingly common. The prevalence of pregnant people with cardiac conditions has increased by about 24% in the past decade. This is driven by rising rates of obesity, diabetes, hypertension, and advancing maternal age.
But awareness hasn't kept pace. Too many people — including healthcare providers — don't recognize the warning signs until it's too late.
What Pregnancy Does to Your Heart
Pregnancy puts enormous demands on your cardiovascular system. Understanding these changes helps explain why heart problems can emerge or worsen during pregnancy:
Blood volume increases by 30-50%. Your body is producing blood for two. This means your heart has to pump harder.
Heart rate increases by 10-20 beats per minute. Your heart is working overtime throughout pregnancy.
Cardiac output increases by 30-50%. The amount of blood your heart pumps per minute goes up significantly.
Blood pressure changes. It typically drops in the second trimester, then rises again in the third trimester.
The heart physically enlarges. Your heart muscle actually grows to handle the increased workload.
For most healthy people, these changes happen without problems. But for those with underlying heart conditions — diagnosed or not — pregnancy can push the cardiovascular system past its limits.
The Pregnancy Complications That Affect Your Heart
Several pregnancy-specific conditions are directly linked to cardiovascular health — both during pregnancy and for years afterward:
Preeclampsia
2.7x increased risk of later heart diseaseHigh blood pressure after 20 weeks of pregnancy, combined with protein in the urine or other signs of organ damage. Preeclampsia affects about 5-8% of pregnancies and can lead to stroke, heart failure, and death if untreated. It can also trigger heart failure in up to 30% of people with pre-existing heart conditions.
Gestational Hypertension
67% increased risk of later heart diseaseHigh blood pressure that develops after 20 weeks without the other features of preeclampsia. It increases stroke risk by 83% later in life. Even "mild" gestational hypertension is a red flag for future cardiovascular health.
Gestational Diabetes
68% increased risk of later heart diseaseDiabetes that develops during pregnancy. It increases the risk of Type 2 diabetes after pregnancy by 10-fold, and Type 2 diabetes is a major cardiovascular risk factor.
Peripartum Cardiomyopathy
Higher rates in Black womenHeart failure that develops in the last month of pregnancy or within 5 months after delivery, without any other identifiable cause. Black women have significantly higher rates than other groups and experience worse outcomes, including lower rates of heart function recovery.
Preterm Delivery
2x increased risk of later heart diseaseGiving birth before 37 weeks is strongly associated with future heart disease and stroke. The earlier the delivery, the higher the risk.
Warning Signs Everyone Should Know
Here's the tricky part: many symptoms of heart problems overlap with normal pregnancy discomforts. Shortness of breath? Swelling? Fatigue? These could be normal — or they could be danger signs.
Severe shortness of breath — especially at rest or when lying down
Chest pain or pressure — any chest discomfort warrants evaluation
Racing heartbeat or palpitations — especially if sustained or accompanied by dizziness
Severe swelling — particularly sudden swelling in face, hands, or one leg
Fainting or near-fainting
Coughing up blood or pink/foamy mucus
Severe headache that won't go away — could indicate preeclampsia
Vision changes — seeing spots, blurry vision, light sensitivity
The American Heart Association has developed a screening algorithm that, when used properly, could identify 88% of pregnancy-related cardiovascular deaths before they happen. That's how preventable many of these deaths are — if we're paying attention.
The Racial Disparity Is a Cardiac Disparity
We can't talk about maternal heart health without talking about race.
These disparities aren't because of biological differences. They're driven by:
Chronic stress from racism — which affects cardiovascular health over a lifetime
Implicit bias in healthcare — leading to Black women's symptoms being dismissed or undertreated
Differences in access to care — including access to high-quality hospitals with cardiac expertise
Social determinants of health — including housing, nutrition, and environmental factors
Addressing the maternal mortality crisis means addressing cardiovascular health inequities head-on.
What You Can Do
Before Pregnancy
Know your numbers: Blood pressure, cholesterol, blood sugar. Get them checked before pregnancy if possible.
Talk to your provider about any family history of heart disease, high blood pressure, or pregnancy complications.
Manage existing conditions: If you have hypertension, diabetes, or other conditions, work with your care team to optimize them before conceiving.
Heart-healthy habits: Regular physical activity, balanced nutrition, adequate sleep, and stress management all support cardiovascular health.
During Pregnancy
Keep all prenatal appointments. Blood pressure and urine are checked at every visit for a reason.
Report symptoms immediately. Don't dismiss chest pain, severe headaches, or unusual swelling as "normal pregnancy stuff."
Ask about aspirin. For high-risk individuals, low-dose aspirin started in late first trimester can help prevent preeclampsia.
Stay active. Moderate exercise during pregnancy may improve vascular function and reduce preeclampsia risk.
Advocate for yourself. If something feels wrong, push for evaluation. You know your body.
After Pregnancy
The highest-risk period is AFTER birth. Most pregnancy-related cardiovascular deaths occur between 42 days and 1 year postpartum. Don't let your guard down.
Attend your postpartum visits. The 6-week check isn't just about your uterus — it's about your whole body, including your heart.
If you had pregnancy complications, you need ongoing monitoring. Preeclampsia, gestational diabetes, and preterm delivery are all risk factors for future heart disease. Tell every provider you see about your pregnancy history.
Breastfeeding may help. Research suggests lactation may lower a woman's later-life risk of cardiovascular disease and metabolic disorders.
Continuous support during pregnancy, birth, and postpartum.
A doula can help you advocate for yourself and navigate a complex healthcare system.
Why Doulas Matter for Heart Health
You might wonder what doulas have to do with cardiovascular health. Here's the connection:
Stress reduction. Continuous labor support reduces stress hormones, which affect cardiovascular strain during birth.
Advocacy. Doulas help clients communicate symptoms and concerns to medical staff — crucial when warning signs might otherwise be dismissed.
Postpartum support. Postpartum doulas check in during the highest-risk period, when cardiovascular complications can emerge.
Addressing disparities. Community-based doulas who share clients' backgrounds can help bridge communication gaps and ensure concerns are taken seriously.
Heart health isn't separate from birth support — it's central to it.
Your heart works harder than ever during pregnancy. Cardiovascular conditions are the #1 cause of maternal death. Warning signs should never be dismissed. And pregnancy complications can affect your heart health for decades. Know the signs. Advocate for yourself. And don't skip that postpartum care — your heart needs monitoring long after baby arrives.
Love,
Maddy the Doula Lady 💙
Your heart matters. Your birth matters. You matter.
Get the support you deserve during pregnancy, birth, and beyond.
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Mary's Hands Network provides free doula support to families across Louisiana.
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