The problem of obesity continues to grow in the U.S., which means more women are becoming pregnant while they are carrying excess weight. According to data from the March of Dimes, 22.8 percent of women of childbearing age in Washington, D.C., are obese.

Pregnancy is a strain on the hearts of women who are at a healthy weight—obesity compounds these cardiovascular risks. However, cardiologists can help women reduce their risk for dangerous heart conditions before, during, and after pregnancy.

Before Pregnancy: Proactive Heart Care for Women at Risk

The best-case scenario is that women with obesity see a cardiologist before they become pregnant. We can start making a plan to reduce a woman’s risk for obesity-related heart disease during pregnancy well in advance, such as:

• Adjusting the type or dosage of current medications
• Nutritional guidelines to reduce the risk of heart disease, such as the DASH diet (Dietary Approaches to Stop Hypertension)
• Regular cholesterol checks by their primary care doctor
• Ways to reduce high blood pressure if necessary
• Whether they’re active and, if not, how to start a heart-healthy exercise routine

These healthy steps can reduce women’s risks for heart attacks and strokes before pregnancy places added stress on their hearts.

Think of pregnancy like an elective surgery. Before scheduling your procedure, we would look at the guidelines for who is a good candidate and make adjustments to improve your chances of a good outcome before the day of your surgery. The same basic principle applies to pregnancy. A cardiologist can help you take healthy steps ahead of time to improve your chances of a healthy, lower-risk pregnancy for you and your baby before you ever become pregnant.

During Pregnancy: What’s Normal and What Isn’t

So many heart condition symptoms are easy to brush off as “normal” pregnancy symptoms, such as heartburn or fatigue. However, certain symptoms should be red flags that a woman’s heart health is at risk, particularly if she is obese.

For example, it can be tough for pregnant women to catch their breath sometimes, and that can be normal, especially in the third trimester, with the growing baby pushing up against the lungs. But shortness of breath could be a sign of a pulmonary embolism—a potentially fatal condition—if it comes with the following symptoms:

• Bluish skin around the lips or fingers
• Chest pain
• Rapid pulse

A cardiologist can help women with obesity identify what is normal and when it’s time to get help. We provide guidelines to all obese women who are pregnant and at risk for potential heart problems that can be fatal for both mom and baby.

After Pregnancy: Continuing Heart Care for New Moms

Unfortunately, the risks of obesity during pregnancy don’t necessarily stop once the baby is born. Moms who develop obesity-related heart conditions while they are pregnant often need help managing them after delivery. We are seeing more of these issues in the “fourth trimester,” or that critical time after pregnancy in which the body is transitioning to its new post-baby status.

Depending on how serious a woman’s heart-related risks were during her pregnancy, a cardiologist is sometimes the first doctor she sees after leaving the hospital—even before she goes back to her Ob/Gyn for her six-week checkup. Gestational diabetes, a type of diabetes that develops during pregnancy, can cause dangerous complications for the heart. A 2017 study in the medical journal JAMA Internal Medicine found that women with a history of gestational diabetes during pregnancy had a 43 percent greater risk for heart attack or stroke over their lifetimes compared to women who never developed gestational diabetes. Women who had gestational diabetes during their pregnancies also are 10 times more likely to develop type 2 diabetes within 10 years after delivery, so it’s something many women have to consider long after their babies arrive.

Peripartum cardiomyopathy, a rare form of heart failure, can develop during the last month of pregnancy or up to five months after delivery, and it can lead to decreased blood flow to the body’s vital organs. Obesity is a major risk factor for peripartum cardiomyopathy, and patients with severe cases might require a heart transplant or a left-ventricular assist device (LVAD).

Women who develop peripartum cardiomyopathy can be some of the hardest for me to treat personally. Though it’s possible for us to manage the disease and help women live normal lives afterward, some women sustain such damage to the heart that we have to advise them against becoming pregnant again. When a woman has an idea of what her family will look like, and I have to tell her that her plans have to change, it can be devastating for her.

The heart-related consequences of pregnancy can linger for a lifetime, particularly for women who are obese. With focus, drive, and support from a cardiologist, you can make the healthy lifestyle changes needed to protect your heart during and after pregnancy.