The birth of her twin boys, Oliver and Ethan, should have been a time of great joy for Stacey Green. Instead, a heart problem triggered by pregnancy meant their birth was overshadowed by a terrifying decline in Stacey’s own health, which left her fighting for her life.
Even now, five years on, 38-year-old Stacey, a council tax officer, has high blood pressure which, even at her age, puts her at risk of stroke and means she must take daily medication to control it for life.
The pregnancy itself had been relatively straightforward, with no obvious warning signs. Then, just a few weeks before giving birth in May 2015, Stacey developed breathlessness and even day-to-day tasks such as making a cup of tea left her gasping for air.
Even now, five years on, 38-year-old Stacey, a council tax officer, has high blood pressure which, even at her age, puts her at risk of stroke. Pictured with her twin boys Oliver and Ethan
‘It felt like a fully grown adult was permanently sitting on my chest,’ says Stacey, who lives in Cumbria with partner Ben, 35, director of a manufacturing company.
‘Everyone, including my GP and midwife, told me it was normal to feel that way because of the physical strain on my body of carrying twins.’
In fact, Stacey had developed peripartum cardiomyopathy, a weakness of the heart muscle that can occur in mums-to-be during the late stages of pregnancy.
It is caused when the heart, charged with supplying oxygen to a foetus — in Stacey’s case, two — as well as the mother’s organs, weakens under the strain. The left ventricle, its main pumping chamber, rapidly becomes weak and floppy.
If caught early, peripartum cardiomyopathy can be treated with drugs such as beta blockers, diuretics and ACE inhibitors to make the heart beat more slowly and pump more efficiently, thereby conserving its remaining strength and giving it a chance to recover.
Stacey developed peripartum cardiomyopathy, a weakness of the heart muscle that can occur in mums-to-be during the late stages of pregnancy
But left untreated, within weeks — even in young, otherwise healthy women — the condition can lead to heart failure (with symptoms such as severe breathlessness and fatigue) and even death.
In Stacey’s case, the peripartum cardiomyopathy wasn’t picked up until a week after she’d given birth, and around a month after the symptoms started, by which time she was in a critical situation.
‘I knew something was wrong even that first day home,’ she recalls. ‘My legs were extremely swollen and I was gasping for air. I just couldn’t get enough oxygen into my lungs.’ Panic-stricken, Stacey called NHS 111, but by the time a doctor returned her call she felt slightly better.
In Stacey’s case, the peripartum cardiomyopathy wasn’t picked up until a week after she’d given birth
Yet six days after she’d given birth, Stacey was gravely ill.
‘I had a cough that sounded like a rattle in my throat and a raging fever,’ she recalls. ‘It was a warm day but I was shivering.’
Ben phoned the GP out-of-hours service and, fearing it was sepsis, they told him to rush Stacey to A&E. She was then admitted to a high dependency unit.
‘It was terrifying and I genuinely thought that I was going to die,’ Stacey says.
Tests showed that her heart’s ejection fraction — how much blood it pumps out of the main chamber with each heartbeat — was only 40 per cent. It should be 50 to 70 per cent, and anything less than 40 per cent is heart failure.
Doctors confirmed she had peripartum cardiomyopathy.
‘I feel that while the babies were monitored and looked after very well during pregnancy, I wasn’t,’ Stacey says. ‘I worry that a lot of pregnant women feel they are often not listened to and that their health isn’t taken seriously.’
THE TIP OF THE ICEBERG?
Stacey’s is an extreme example, yet evidence suggests it may be the tip of the iceberg when it comes to the impact and damage that pregnancy — and pregnancy-related disorders — can have on women’s hearts.
These have now been linked with high blood presssure, type 2 diabetes and an increased risk of heart attack and stroke. And some campaigners fear these risks are not being taken seriously by doctors who are largely unaware of the impact pregnancy can have.
Compounding the problem is the fact that, in some cases, the damage may not be fully apparent until years, even decades, later.
Yet six days after she’d given birth, Stacey was gravely ill. Seen with the baby twins
For example, the pregnancy-related condition pre-eclampsia, which causes dangerously high blood pressure in the mother, was previously considered ‘cured’ once the baby was delivered. Recently, though, it’s been found to cause permanent damage in some women that can dramatically increase their risk of a heart attack, heart failure or a stroke in later life.
Pre-eclampsia affects one in 50 pregnancies a year and occurs when blood vessels in the placenta fail to develop properly. As a result, the extra blood and plasma produced to supply both mother and baby’s needs are squeezed into the mother’s blood vessels, raising her blood pressure.
Common signs include swelling of the feet, ankles and face (caused by the body retaining fluid), as well as severe headache and blurred vision. The exact causes are unclear but the risks increase if women have a family history of the condition, or are over 40 and already have high blood pressure or diabetes.
Babies can be born premature or may die in the womb, due to the lack of nutrients reaching them. The condition can also prove fatal for the mother.
Scientists have recently found an alarming link between pre-eclampsia and heart disease later in life.
In 2017, in a review of 22 studies, researchers at Keele University found that women who had suffered pre-eclampsia were four times more likely to experience heart failure when they got older and twice as likely to die from a heart attack or stroke than women who did not develop it.
Doctors confirmed Stacey had peripartum cardiomyopathy after she was rushed to A&E
The results, published in the journal Circulation: Cardiovascular Quality and Outcomes, showed the risks begin to increase within one year after birth, peaking at around ten years after.
It now seems the damage to the cardiovascular system that occurs with pre-eclampsia is never fully repaired, putting women on the path to early-onset heart disease, regardless of other factors such as their lifestyle.
‘Around 40 per cent of women who suffer pre-eclampsia will have high blood pressure by the time they are 40,’ says Dr Angela Maas, a cardiologist and world-renowned expert on women’s heart health from Radboud University in the Netherlands.
‘High blood pressure is the number one deadly risk factor for heart disease in women,’ she says. ‘While in a man aged 40, high blood pressure would be considered a major risk factor that needs treating, in a woman, doctors are often more inclined to blame it on the stress of maybe running a household, bringing up children or caring for elderly parents.’
DOCTORS FAILING TO TRACK THOSE AT RISK
The Keele University team urged the medical profession to use their findings as a basis for increased monitoring of at-risk women, particularly in terms of high blood pressure.
However, experts told Good Health they fear that many women are slipping through the net.
Dr Brian Halliday, a lecturer in cardiology at Imperial College London and the Royal Brompton Hospital, London, fears there is a general consensus that one episode of pre-eclampsia in a woman in her 20s or 30s cannot possibly damage the heart permanently, but the evidence suggests it can.
‘These women are often not followed up as closely as needed, even though we know they are more likely to face heart problems in the future,’ he says.
Stacey’s bump whilst pregnant with Ethan and Oliver. I feel that while the babies were monitored and looked after very well during pregnancy, I wasn’t,’ Stacey says
‘We need to be more aggressive when it comes to monitoring these women after they give birth. We need to look at these women regularly, years after, and check for high blood pressure, raised cholesterol and diabetes.
‘They need to be checked and given lifestyle advice such as losing weight, quitting smoking and getting more exercise — all factors which can further raise their risk of heart disease if they are already vulnerable. They need to be particularly careful about reducing risk factors for heart disease.’
Possible risks for children, too
Pre-eclampsia — high blood pressure during pregnancy —may affect the child’s future cardiovascular health as well as that of the mother (see main story).
A 2012 study by the University of Oxford, involving more than 45,000 people born to mothers with the condition, found that even in childhood and adolescence they had higher blood pressure readings than peers who had not been exposed to pre-eclampsia.
The researchers said raised blood pressure at such a young age was a red flag for problems later in life. Dr Clare OliverWilliams, a cardiovascular researcher, says babies who are exposed to high blood pressure in the womb ‘adapt to that environment’ — in other words, their developing cardiovascular system is being taught that higher blood pressure is normal.
‘If the foetus is growing in the womb and blood pressure is high, then that’s what it becomes used to and its body adapts to that,’ she says. This then becomes the default setting for the child’s blood pressure once it is free from its mother’s own blood supply.
Dr Patrick O’Brien, spokesman for the Royal College of Obstetricians and Gynaecologists, says that in the first year after they had pre-eclampsia, women should have monthly checks, followed by annual GP visits after that.
‘And they need to be told at the outset that their risk of heart disease has roughly doubled due to pre-eclampsia,’ he says — which at the moment they are not routinely told.
‘Even if you just had high blood pressure during pregnancy, without pre-eclampsia, it would still be sensible to have an annual check.’
Dr Maas believes all women who have had pre-eclampsia should routinely have a CT scan (a type of X-ray) of their coronary arteries when they reach 45, to see if they have excess calcium deposits that narrow blood vessels and raise the risk of heart attacks.
If detected, these could be treated by implanting a stent — a tiny metal tube — to prop open the affected artery and keep blood flowing to the heart.
‘At the moment, there are no clear guidelines on what to do with these women,’ she says. ‘But we are learning that prevention has to start early.’
HIGH BLOOD SUGAR ANOTHER RED FLAG
Gestational diabetes, which in the UK affects up to one in six pregnant women, can also affect a woman’s long-term heart health.
The condition causes a spike in the woman’s blood sugar levels that only recedes once she’s given birth. It occurs when the pancreas cannot produce enough insulin (the hormone that helps the body’s cells to use up blood sugar) to meet the extra needs of pregnancy.
Most women experience few symptoms and the condition usually gets picked up during routine antenatal checks.
Those who are obese, or have had the condition in a previous pregnancy, or are from certain ethnic groups, such as those of South Asian, African Caribbean, or Middle Eastern background, are generally more at risk.
peripartum cardiomyopathy, the condition that Stacey Green developed, is relatively rare, affecting around 700 women a year in the UK and accounting for around 40 deaths
Without treatment, either with tablets or insulin jabs to lower blood sugar, gestational diabetes can lead to the baby growing larger than usual, increasing the risk of difficulties during delivery.
Studies have now shown that a woman who suffers gestational diabetes is 50 per cent more likely to develop type 2 diabetes, a major risk factor for heart disease, in the next five to ten years.
The added burden of larger families
Pregnancy disorders are not the only threat to a mother’s heart. Having more than two children increases the chances of a future heart attack by 40 per cent, according to a 2018 study by the University of Cambridge.
But it is still not certain whether this is due to the strain of birth itself, or simply that busy mothers with more children have less time to look after their own health.
‘That’s the big question,’ Dr Clare Oliver-Williams, one of the researchers involved in the Cambridge study, told Good Health. ‘We know that the more pregnancies a woman has, the more likely she is to suffer complications — such as pre-eclampsia — that may be linked to heart problems later in life.
‘But we also know from studies involving fathers that those with more children are also at increased risk of heart disease, so it may be due to the burden of a larger family.’
There are other potential dangers, too. In January, data from 1,100 women gathered by the Kaiser Permanente Division of Research in Oakland, California, found that women who’d had gestational diabetes were twice as likely as those who didn’t to have calcium deposits accumulating in the arteries around their hearts by the time they reached their 40s and 50s.
Researchers said they were surprised to discover that even those whose blood sugar levels reverted to healthy levels straight after birth — and remained at those levels — were still more likely to have a dangerous build-up of calcium linked with heart attacks, reported the journal Circulation.
‘We now know that even if your blood sugar levels return to normal straight after pregnancy, and stay there, your heart disease risk is elevated,’ says Dr Maas.
WHEN TO SEEK HELP FOR BREATHLESSNESS
peripartum cardiomyopathy, the condition that Stacey Green developed, is relatively rare, affecting around 700 women a year in the UK and accounting for around 40 deaths — many of them perfectly healthy young women.
It’s not clear what triggers it, although risk factors include obesity, smoking and chronic illness such as type 2 diabetes.
None of these applied to Stacey, however, and recent research suggests up to 15 per cent of cases may be due to a genetic predisposition.
The charity Cardiomyopathy UK has now launched a campaign, Beating For Two, to raise awareness of condition among the public and the medical profession.
The charity warns: ‘Opportunities to detect and treat peripartum cardiomyopathy early are being missed and, as a result, women’s lives are being put at risk.’
Dr Brian Halliday adds: ‘It is important to raise awareness of this condition. Feeling like you need to put a bit more physical effort in during pregnancy is quite normal.
‘But if you have to stop halfway up the stairs because you simply cannot catch your breath, or if you wake in the night gasping for air, that’s not normal.
‘Pregnant women must get help if they have to stop for breath halfway up the stairs, are suffering heart palpitations or have been blacking out.’
A Woman’s Heart: Why Female Heart Health Really Matters, by Dr Angela Maas (Octopus, £9.99).