Evo Terra (Host): It goes without saying that pregnancy has a big impact on the future mother's health. But what about her heart health? We'll talk about that today with Dr. Jessica Meyer, a cardiologist on the medical staff at Baylor Scott & White Heart and Vascular Hospital, Dallas.

Baylor Scott & White Heart and Vascular Hospital, Dallas, Fort Worth, and Waxahachie. This is HeartSpeak from Baylor Scott & White Heart and Vascular Hospital, Dallas. I'm Evo Terra. Welcome to the show, Dr. Meyer.

Dr. Jessica Meyer: Thank you so much for allowing me to be here. I'm excited.

Host: You are very welcome. Let's start this conversation from the beginning. How does pregnancy affect a woman's heart health?

Dr. Jessica Meyer: Pregnancy is just a different physiologic state from the previous physiologic state that the woman would have been in, but the, heart is going to have to do extra work because essentially you're going to end up circulating extra blood because you're going to have another body, another baby, a human essentially, that you'll be growing inside of you, that's going to have its own blood volume and blood source, but it's going to need that circulated. And so, the mother is going to have to help move that, circulate that to help that baby grow.

So essentially, her heart is going to have to pump out extra blood. It's also going to have to deal with a different resistance. And so, there's going to be a lot of stress that can be on the woman if the woman's heart is not already in good condition. So, it's good to keep that in mind whenever you're getting pregnant, is my heart healthy to carry this pregnancy and have this baby?

Host: Yeah, all of that makes obvious sense. There's more to work with, and the heart definitely has to do more. So, getting a little more specific, what causes some impacts on the woman's heart? I mean, obviously, we have a growing fetus inside of us. But specifically, what symptoms should a pregnant woman be looking for?

Dr. Jessica Meyer: So, this can kind of be confusing, which is where seeing a doctor or even a specialist, whether it's primary care physician or an OB-GYN if they need help because it can get a little confusing, because some of the pregnancy symptoms that you'll have from the growing fetus and the increase in blood volume that the mother is circulating can be similar to heart symptoms.

So with pregnancy in general, you can get short of breath, especially into the third trimester, just with the changes in the body and the hormones. You're going to get a little short of breath depending on how the baby is in the body. You could even have a vein get compressed and you can have some swelling in the legs too. And you could even have issues with breathing and sleeping at night too. But if any of those get exaggerated or out of proportion or different from the norm, or if you hear a heart murmur that you're concerned about, some heart murmurs essentially, which would just be essentially extra flow across the valve, because there's going to be extra flow that the mother's moving. There could be a heart murmur that's present that's just benign and normal during pregnancy, but also there could be some that are present that are abnormal. So, if there's ever any confusion, it's totally very acceptable to reach out to a cardiologist or a medical professional to help clarify or give any kind of extra feedback as to does this need to be evaluated further, is this normal to be expected, or would something else be going on here that needs to be evaluated to make that sure I'm safe during the pregnancy and the outcomes are good?

So essentially, shortness of breath, swelling, issues with like fatigue with exertion, anything out of proportion than normal compared to a prior pregnancy is usually very helpful. But if there's any symptom that's very exaggerated or very limiting or you're very concerned about it, it's more than acceptable to be evaluated by a cardiologist or a medical professional just to get extra clarification on the issue, because it can be confusing.

Host: Yeah, definitely. As you say, there are a lot of changes that the body is going through. And if it's someone's first pregnancy, I'm sure everything is going to be brand new throughout that process. I'm curious, we're all about personal responsibility and, yes, definitely talk to your doctor, talk to your OB-GYN if you have any concerns whatsoever. But again, personal responsibility is big. Is there something that pregnant woman can do to mitigate these possible risks to her heart health?

Dr. Jessica Meyer: I think anybody who engages in a heart-healthy diet or cardiovascular exercise is going to be making their heart strong, is going to be conditioning their heart. Essentially, you're going to be feeding your heart the nutrients and vitamins that it needs, and then you're going to be conditioning it to higher heart rates, so it's going to be stronger at rest and at its baseline than it would have been before, because it's used to working harder during that exercise, so then it gets stronger at rest. So then, that's going to set your heart up for success, especially in pregnancy, whether you have a significant heart condition or not. I mean, heart conditions could just be as simple as hypertension and even diabetes too. So, it doesn't have to be a heart failure or necessarily a valve problem. But a healthy diet and engaging in some kind of level of activity would be something that a woman could do. If there's any kind of concern, because a lot of women are also getting pregnant older, and some of them are also seeking help with getting pregnant as well, just with difficulty with conceiving. So, there's also no problem with asking for advice or seeing someone and talking to them about it if there's a condition that they're concerned about. If there's a medication they're not sure they could continue during pregnancy, they can seek professional help with that specialist that's giving it to them or they could seek like a cardio-obestetric specialist to talk about that, especially if it relates to the heart.

Host: You brought up medications. And I want to follow on with a question about that. I can remember 34 years ago when my wife was pregnant, there was always that concern of what medication someone could take. So from a physician standpoint, and I guess without talking about individual specifics, what can you do if something needs to be done? What kind of intervention and treatments are available?

Dr. Jessica Meyer: So, that's going to depend on like the heart condition within pregnancy. So for heart failure, for instance, for example, there are certain meds that you can't be on just because they will interact and cross across the placenta and affect the baby. And then, there are some that you can continue on and then there are some that you can start on later and some that you would start after delivery if you're not breastfeeding. So, it's very situational. Generally, beta blockers, that class of beta blockers are generally benign and can be given, certain types within the group of that class. We can give certain blood pressure medications during pregnancy, like labetalol, nifedipine. We can also give hydralazine if we need to. And then, there's other specific heart failure meds that we can also give later in the third trimester or even after pregnancy. If the woman's no longer breastfeeding and there's not a concern that the medication would cross through to the breast milk and affect the baby, then, we can give those then too. It's kind of a loaded question.

But if a woman does have a medical condition and she is pregnant or prior to pregnancy, if she's really struggling, there are procedures that can be done that a cardiologist can help kind of set up with either an interventionalist or an electrophysiologist, essentially the stent doctors and the electrical doctors. If that needs to be done, there are procedures that can be done. Valves can be fixed. We try to prevent from having to do that until we really have to. And we also try to address those things beforehand, which is where preconception counseling can be very helpful and important as you can game plan and see is this something that I should address now? Am I safe to proceed with pregnancy? Do I just need to be monitored and watched or is pregnancy not a good idea for me? So, if a woman has pulmonary artery hypertension, that's a high blood pressure in the lungs, that's a very serious condition. She's not going to tolerate a lot of that increase in blood volume, especially during labor and delivery when you have all these fluctuations within your blood pressure and heart rate just with the stress of delivery. So, it is strongly advised that those women do not get pregnant, because they will not tolerate pregnancy.

Host: All make sense. You know, one of the great things about living in 2024 is it's almost the future. And definitely, from 34 years ago when my wife was pregnant, a lot of things have changed. What are stats looking like about how safe is pregnancy these days? What does the mortality rate look like and specifically in the state of Texas?

Dr. Jessica Meyer: It's definitely not number one. It's not the best. I think, Louisiana, Arkansas, and Mississippi rank amongst the top in regards to worse maternal mortality and morbidity. And Texas is going to kind of be in like that upper quarter, upper third. I think, it's Massachusetts and, New York or California that are the top. So, we're definitely in the upper quarter in regards to being the worst for maternal morbidity and mortality, but we're not the worst state.

Host: So, some room to improve.

Dr. Jessica Meyer: Yeah. There's definitely room improve for sure.

Host: Let's talk about that improvement. I know that the pregnancy heart team at Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital Dallas are doing something about that. Talk to me about that team.

Dr. Jessica Meyer: Yeah. So, the Pregnancy Heart Team, essentially. It's a cardio-obstetrics program. There's probably maybe five well-organized, multidisciplinary, meaning multiple different specialties and fields of medicine involved in a pregnancy care team across the nation. But the one that's unique about Baylor is we have a very strong advanced heart failure group.

We have ECMO, which is extracorporeal membrane support, essentially that life support, that heart lung bypass that might be emergently needed. We have a very strong, very responsive, very resourceful system and team that actively are involved in our pregnancy heart team. And we have cardio OB anesthesia. We have maternal-fetal medicine. Obstetric-minded cardio OB obstetricians, as well as cardiologists, interventionalists and EP doctors, electrophysiologists. So, we have so much within our diversity. And within that diversity, it's people who are very passionate about cardio-obstetric health. But what really, I think, you know, makes us unique is that bypass, that ECMO support and the advanced heart failure team that we are tied with, and the cardiac ICU, that's not seen in a lot of places that I know of. Most centers might have maternal-fetal medicine, a heart failure, maybe a cardiologist and an OB, but they don't have as big a diverse of a team, especially with that ECMO and that heart failure support. So, we're probably one of the more unique programs within the nation right now. And I'm very excited about that, because I'm hoping that we can help get more data out there, get more education out to the public and, essentially, promote maternal health within pregnancy and try and change the stats as best as we can.

Host: Any final points you wish to make?

Dr. Jessica Meyer: Yeah. I think the only leaving point that I would leave here is if you have any question about your cardiovascular health, whether that is before pregnancy, during pregnancy, or after pregnancy, please reach out to a medical professional. I think that is the one thing that can be a game-changer that we can do right now in regards to changing the statistics, in regards to making maternal health better within the United States. It's going to be education. That's something that we can do from the doctor's standpoint that doesn't involve politics and government changes. Because when you're trying to change insurance policy, and extend care and try and get more people access to care, sometimes you end up having to move more into the political realm.

But from our standpoint, I think just making women aware of this topic so that they can advocate for themselves and reach out and search for help. If they have a question and advocate for themselves, I think that's the most important thing, is just making sure people are aware of this, because most people aren't aware that the maternal mortality and morbidity rate within the United States is so poor. I mean, we are the worst developed nation when it comes to this. And I don't think everyone's really aware of that. Even within the medical field, I don't think everyone's really aware of that. So, I just want to make that known so that more people can advocate for themselves and reach out for care.

Host: Solid advice. Dr. Meyer, thank you very much for being on the program with me today.

Dr. Jessica Meyer: You're welcome. It was very exciting ,and I hope it was able to help some people.

Host: That's Dr. Jessica Meyer, cardiologist on the medical staff of Baylor Scott & White Heart and Vascular Hospital, Dallas. For more information about women's heart health, contact the Women's Heart Center at Baylor Scott & White Heart and Vascular Hospital, Dallas at 214-820-7162. Again, that's 214-820-7162.

And if you found this podcast episode helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. I'm Evo Terra, and this is HeartSpeak from Baylor Scott & White Heart and Vascular Hospital. Thanks for listening. Baylor Scott White Heart and Vascular Hospital, Dallas, Fort Worth, and Waxahachie,

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