Women and Heart Disease
Heart disease is the number one killer of women in Canada. The top risk factors for heart disease are smoking, obesity and diabetes. Yet, many women without any of these conditions will develop heart disease. Clearly, the traditional male-centric models of heart disease risk do not always apply to women, which is why researchers are working to identify and develop new risk factor models that are specific to women.
As director of the clinician investigator program in the maternal-fetal medicine division at Kingston General Hospital, Dr. Graeme Smith, has proposed pregnancy and the postpartum period as the best time for women to be screened for heart disease risk factors. He describes pregnancy as a physiologic stress test, one that can reveal underlying problems. Failure of the stress test, meaning development of certain pregnancy complications, indicates an increased risk of developing heart disease.
This new and unique approach to screening for heart disease risk factors is being used in his Postpartum Maternal Health Clinic at Kingston General Hospital. This clinic - the first of its kind in North America - is available at 6 months postpartum to women who experienced pregnancy complications including; preeclampsia, HELLP syndrome, gestational hypertension, gestational diabetes, gestational impaired glucose tolerance, intrauterine growth restriction, a term baby less than 2500g, idiopathic preterm delivery or placental abruption. The goals of the clinic are to promote mothers' health, screen for heart disease risk factors and educate women on the links between pregnancy complications and heart disease. Dr. Smith hopes that his clinic and approach to screening can help address this need for education and empower women to take steps to prevent heart disease.
About the Maternal Health Clinic
During your pregnancy and the postpartum period, you will be accessing the health care system on a regular basis - perhaps for the first time. For most women of reproductive age, this provides a new, early window of opportunity to identify risk factors and implement screening and intervention strategies that may improve your long-term health. In this regard, I have recently set up a Maternal Health Clinic in which I will be seeing women who have had one or more of the following pregnancy complications:
- High blood pressure in pregnancy (pre-eclampsia, gestational hypertension, toxaemia)
- Gestational diabetes or glucose intolerance in pregnancy
- Premature birth for any reason (Less than 37 weeks gestational age)
- Delivery of a growth restricted baby
- Placental abruption
When women with the above criteria are assessed, we will review their pregnancy(s) and any complications, as well as their past medical history and their family medical history. We will measure their blood pressure, weight, height and waist circumference and calculate their Body Mass Index (BMI). We may also do blood work for cholesterol, lipids and glucose and a urine test for protein.
The Maternal Health Follow Up Form that I have developed is to be used by health care providers to record this information and calculate a woman’s lifetime risk for heart disease and stroke (the leading cause of death in women) in order to help them improve their patients’ long-term health. Women with a high lifetime risk for heart disease and stroke may benefit from lifestyle modification, dietary counselling, drug therapy, smoking cessation programs and regular follow up.
The Postpartum Mother’s Health Record is designed for the mother’s use. We have timed the collection of information to coincide with your baby’s scheduled visits and immunizations. Use the card to help set goals and keep track of weight loss. Keep the card with your baby’s immunization card as a reminder of when to record the information. Give a copy of the completed card to your health care provider at the end of your first year postpartum and review it with him or her for any further suggestions.
Feedback from Program Participants
"Upon hearing from the Mother's Program after my second pregnancy I was a little surprised as I had been active throughout my pregnancy and felt that I had better managed my weight than with my first, however I did start out several pounds heavier, and still gained a fair amount of weight. At my meetings with several health professionals, I was provided with information of a simple and practical nature with regards to potential future health and wellness implications and some basic suggestions for making improvements. It seems that genetics could be a little stacked against me, so that information provided me with enough incentive to work on the things that were within my control, namely, improved health through better eating habits and increased fitness levels. I reduced my weight and body fat percentage and started my third pregnancy in my best condition in years and have maintained a good level of fitness, health and weight gain. I feel fortunate that I have the information provided by the Mother's Program as it will keep me motivated as I look forward to continuing on the path to improved fitness and wellness after delivery and recovery."
- Krista D.