Key Opinion Leader Interview with Dr Margaret Arstall on Pregnancy as a risk factor for heart disease

​​​Interview carried out with Dr Linda Worrall-Carter (Founder & CEO of Her Heart) and Dr Margaret Arstall, Director of Cardiology, NALHN, Associate Professor, University of Adelaide

We have enjoyed working with you and your team recently. We would love for others to hear a little more about you and why you are so passionate about women’s heart health.

 When I began the COFFEE clinic (which stands for Cardiovascular Assessment after Obstetric complications: Follow up For Education and Evaluation) it was to provide specialised care to women during pregnancy who are at risk of and have heart disease. This includes women who have high blood pressure,high blood sugar and also have pre-term babies. Pregnancy is often called a “Stress test” as the body can be challenged through the increase in blood volume and some medical problems can arise. The clinic not only provides a clinical service for women with heart disease but is also a resource for other physicians/doctors as well as nurses and allied health to gain information on these less commonly diagnosed conditions. It is also a platform by which we engage women in much-needed research in this area. 

You mention about Pregnancy being a “Stress Test” in a woman’s life, why is it such an important time for assessing women?

Pregnancy is classified as a “stress test” for women because it puts a significant strain on the body’s systems, including the cardiovascular system. Carrying a baby causes an increase in blood volume (as it also includes the blood supply to the baby), as well as an increase in heart rate which can put a strain on the heart and blood vessels. This stress can reveal underlying heart-related issues that may not have been apparent before pregnancy. Additionally, pregnancy can worsen existing cardiovascular conditions such as hypertension or Diabetes. Therefore, it’s important for women to monitor their heart health not only before but during, and after pregnancy. 

Tell us more about what the key issues are for women 

It’s not so widely known that experiencing pregnancy complications can increase a woman’s risk of heart disease in later life. Women who have had high blood pressure or diabetes during pregnancy, or gave birth to a preterm or small baby, are twice as likely to develop heart disease later on. 

What do women need to be aware of if their blood pressure is high? 

Pregnancy-Related Hypertension or Preeclampsia is a condition characterized by consistently high blood pressure during pregnancy, which can impact blood vessels and organs such as the kidneys. It is important to be aware of how you are feeling during pregnancy, so if you have any headaches, dizziness, swelling in the hands, feet, and/or around the face then you must let your specialist and/or GP know. They will assess you and also a simple urine test is used to diagnose this, as it checks for protein in the urine. It is important to make sure you attend any routine appointments as it is important that any signs and symptoms of high blood pressure are picked up early.

What can they do to improve the situation?

If you have experienced high blood pressure during pregnancy, or even if it went away after giving birth, you may be at increased risk of developing high blood pressure. There is the potential for a heart attack or even a stroke as you get older so ongoing monitoring is important. You can also greatly reduce this risk and improve your overall health through regular checks, being aware of any symptoms and being proactive such as not delaying if you feel unwell.

Having a regular check of your blood pressure, not smoking (or taking steps to quit if you do smoke) is extremely important. Engaging in daily exercise such as walking (or at least 3 times a week) will also help with maintaining healthy body weight. Finally, eating a healthy diet rich in vegetables, fruits, and salads and trying to cut down on processed foods. These are often high in sodium (salt) so when you can avoid adding salt to your food and get used to reading food labels.

What do women need to be aware of if their blood sugar is high? 

During pregnancy, some women may develop a condition called gestational diabetes, which means their blood sugar levels are higher than normal. In Australia, around 15% of women are diagnosed with diabetes during pregnancy. This type of diabetes is usually diagnosed between 24 and 28 weeks of pregnancy through a blood test. Insulin is a hormone that helps move sugar from the blood into cells to be stored and used as energy. However, in diabetes, the body either doesn’t produce enough insulin or can’t use it effectively. If not managed properly, high blood sugar levels can cause damage to organs such as the eyes, kidneys, and nerves. It’s important for women to learn about gestational diabetes and take steps to manage it in order to protect their health.

What can they do to improve the situation?

If you had diabetes during pregnancy, you are at an increased risk of developing diabetes after pregnancy and having a heart attack at a younger age than other women. However, there are steps you can take to greatly reduce this risk and improve your health. These include getting your blood sugar checked regularly, quitting smoking or taking measures to quit, exercising every day, eating healthy foods (including vegetables and salads), reducing your intake of sugary foods, and maintaining a healthy body weight.

Are there any other things that we should consider?

When it comes to supporting the health of First Nations women who are at risk of hypertension and gestational diabetes, there are definitely some important additional considerations to keep in mind. Research has shown that Indigenous women in Australia have a higher risk of developing high blood pressure, gestational diabetes, and rheumatic heart disease compared to non-Indigenous women. There are several factors that may contribute to this, such as pre-existing diabetes, poor nutrition, and limited access to healthcare.

One of the key challenges that First Nations women may face is accessing culturally appropriate care and education about gestational diabetes and related health issues. To address this, it’s important that healthcare providers prioritize culturally safe and respectful care for Indigenous women. This might involve working with community health workers, providing language and cultural support, and ensuring that healthcare services are both accessible and affordable. By taking these steps, we can help improve the health outcomes for First Nations women and reduce their risk of developing hypertension, gestational diabetes, and other related health issues.