Cardio-Obstetrics: Supporting Heart Health Through Pregnancy and Beyond.
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During a healthy pregnancy, your heart works overtime. Here’s one example—your total blood volume can double to support the growing fetus, putting extra strain on your heart and blood vessels. And that’s in a healthy pregnancy!

For many patients, pregnancy can be like a crystal ball to predict future heart health. Research suggests that having an adverse pregnancy outcome (APO)—such as preeclampsia, gestational hypertension, gestational diabetes, having a small baby, or delivering early—increases the risk of developing heart disease at a younger age. About 30% of birthing individuals who give birth have an APO, and Black women are more likely to have severe complications with worse outcomes.


Heart-related problems are the most common cause of maternal death. Again, Black women are at higher risk than White patients. 

Data from the U.S. Centers for Disease Control and Prevention (CDC) show that Black birthing individuals are three times more likely to die from pregnancy-related causes than White women. The difference is not about education or income alone—CDC reports that Black women who graduate college die of pregnancy-related causes at nearly twice the rate of white women who did not graduate high school. 

No family should suffer the loss of a new mother, especially to preventable heart complications.

As part of our ongoing work to reduce maternal mortality and eliminate racial disparities in health care, MedStar Health is leading lasting change through our new Cardio-Obstetrics collaboration—a specialist team that will identify patients at risk of cardiovascular problems and take care of women’s hearts before, during, and after pregnancy.

Heart-health through the lens of pregnancy.

Cardio-Obstetrics brings together experts in heart care and pregnancy care to help prevent, identify, and manage heart-health risk factors before they take a toll on your family’s future. 

The Cardio-Obstetrics team will listen to how you feel and what you need at every point of your pregnancy. We will give you an actionable, achievable path to reduce your risk factors, keep your heart healthy, and enjoy a long, active life with your family. 

Our team focuses on three main areas that can have the most immediate positive impact on your health: pre-conception or early pregnancy counseling, prenatal care with a provider you trust, and postpartum and long-term care.

Related reading: Research Helps Us Better Understand the Lived Experiences of Black Women with Severe Maternal Morbidity.

Pre-conception or early pregnancy counseling.

In a perfect world, each patient would start their pregnancy at peak health. But that’s not realistic—about 45% of pregnancies are unplanned in the U.S., and the first time many women see a doctor as an adult is when they become pregnant.

Our Cardio-Obstetric team is all about meeting you where you are. Before or early in pregnancy, we’ll talk through your family health history to identify conditions that may run in your family, such as early heart attack or stroke. If you have a known heart defect or condition, we’ll discuss how you manage it and whether it is safe to become pregnant.

We’ll also give you a baseline of your “heart-health numbers,” such as:

  • Blood pressure: The amount of force of your blood as it flows through your arteries. Chronic high blood pressure can damage the heart, brain, and kidneys. A healthy blood pressure is less than 120/80 mmHg. 
  • Blood sugar: The amount of glucose in your blood, which can identify whether you have pre-diabetes or diabetes. Both can lead to heart or kidney damage if left untreated. A healthy fasting blood sugar level should be less than 100 mg/dL.
  • Cholesterol: A waxy substance that travels through your blood and can deposit in your arteries. Having high cholesterol can increase the risk of a heart attack or stroke. A healthy total cholesterol should be less than 200 mg/dL.
  • Weight: Obesity is a chronic health epidemic in the U.S., and it is associated with multiple heart conditions, diabetes, and several types of cancer. Talking with a cardio-obstetrics specialist will help you understand how much weight is healthy to gain during pregnancy.

From there, we can help you make a plan to optimize your heart health. This may include medications and updates to your diet and exercise routine to improve your overall health. 

The counseling visit is also a good chance to meet our team of cardiologists and obstetricians. We come from all walks of life, all around the world—there is always someone available to really listen to you, understand what you’re going through, and connect you with the best care.

Prenatal care with a trusted provider.

Many of our Cardio-Obstetric providers have been in your shoes—balancing personal health care with family and work responsibilities. We empathize, and we’ll help you follow your heart-healthy pregnancy plan without making your life more complicated.

Our specialists will work to manage your heart and pregnancy care without extra visits when possible. Along with your regular prenatal checkups, we’ll track your heart-health numbers and adjust your medications, if needed. 

If you or your baby develop complications during pregnancy, we will connect you with a maternal-fetal medicine (MFM) doctor. MFMs specialize in caring for patients with high-risk pregnancies, which often need more ultrasounds, medications, or procedures. Your care team will be by your side, keeping you informed of your options and helping you have the safest pregnancy experience. 

In your second or third trimester, we’ll start to plan for delivery and how to maintain your heart health in the weeks after giving birth—what we call the “fourth trimester” of maternal care, which can be a vulnerable time for women’s heart health. 

Our multidisciplinary team members work closely to discuss care plans for our patients with complex health needs. Being close as colleagues, peers, and friends increases our comfortability with calling each other for recommendations, making referrals, and co-managing our patients’ care.

Related reading: Safe Babies Safe Moms Program Sets the Stage for Better Outcomes.

Heart care in the ‘fourth trimester.

The weeks between giving birth and the official postpartum checkup can feel like a blur as you get used to life with a newborn. While it is normal to focus on the baby, remember that you can’t pour from an empty cup. To raise a healthy family, your heart health should be a priority. 

Before you even leave the hospital after delivery, pay attention to how you are feeling. It is not normal to have these cardiovascular symptoms after delivery:

  • Difficulty breathing 
  • Chest pain
  • Feeling like the heart is skipping beats
  • Leg cramps or “hot spots” in the legs
  • Persistent swelling of the ankles

If you notice these symptoms after delivery, be vocal about it until someone helps you. These could be signs of an emergency, such as a blood clot or damage to the heart itself. In 2021, tennis legend Serena Williams began to have trouble breathing after giving birth. She had a history of blood clots and recognized that something was wrong. Despite her star power, she still had to push before her providers would listen to her. 

High blood pressure is another concern we watch for in the fourth trimester. Preeclampsia can develop or continue up to six weeks postpartum, so we will check your blood pressure and may recommend or adjust medications to help keep it under control. If you have or are at risk for very high blood pressure, we can connect you with a cardiologist to help with long-term management. 

Our cardio-obstetric team invests in training sessions with MedStar Health emergency department (ED) staff to focus on blood pressure safety in pregnant and postpartum patients. For example, if a patient comes to the ED with very high blood pressure, the level of concern is higher if she has recently had a baby. A typical patient likely would be counseled about medications or checked for a heart attack. But in a pregnant or postpartum patient, high blood pressure can cause potentially deadly seizures.

Caring for your heart, for life.

It can be challenging to prioritize your own health during pregnancy, especially in those first few sleep-deprived months of motherhood. Many MedStar Health patients use the BabyScripts app from pregnancy through the postpartum period to:

  • Access educational materials on a range of pregnancy-related topics 
  • Track the baby’s growth and development
  • Earn incentives for actively participating in their care
  • Assess their risk for health conditions and social needs 
  • Create personalized reports to share with their doctors

With Cardio-Obstetrics specialists at your side, you will have a team of people who know you, understand you, and will listen to you. And as you heal from delivery, we will keep working with you to manage your heart health. And if you had a pregnancy complication or continue to have high blood pressure or diabetes after pregnancy, we will help optimize your medications to protect your heart for years to come.

A mother is the heart and soul of her family—your health is a compass for the health and happiness of generations to come. The Cardio-Obstetric team is here to support your heart health from the start of your family onward.

Interested in Cardio-Obstetric care?

Click below to schedule an appointment with one of our specialists.

Estelle Darlyse Jean, MD

Ngozi Uzogara Wexler, MD

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