Pregnancy and Cardiac Precautions

The American Heart Association/American Stroke Association Guidelines for Prevention of Stroke in Women reports that although stroke is not common during pregnancy, pregnant women are more at risk for stroke than non-pregnant young women. The guidelines describe the pregnancy-related physiologic factors of venous stasis, lower extremity edema, and blood hypercoagulability as factors in increased risk of stroke. Hypertensive disorders during pregnancy including preeclampsia can also increase maternal and fetal risk, with risk factors of obesity, age over 40, multiple pregnancy, and diabetes.

Postpartum hypertensive issues can also be a concern, and providers should be alert to the symptom of headaches as a potential marker of elevated blood pressure. Although rehabilitation professionals should routinely measure blood pressure in patients, numerous studies have demonstrated that we do not. The referenced guidelines give parameters for blood pressure readings for mild, moderate, and severely high blood pressure readings in pregnancy.

The third trimester and the postpartum period bring the highest risk for stroke, and the authors of the guidelines point out that a stroke can occur with even moderately elevated blood pressure readings. Even if a woman recovers from elevated blood pressure in the peripartum period, she may remain at risk for developing further cardiovascular disease including stroke. Having gestational diabetes, which can later develop into Type 2 diabetes, can also increase stroke risk, meaning that every woman's history related to pregnancy and postpartum cardiovascular health should be taken with interest. Measuring blood pressure regularly is also a habit that therapists must develop.

In addition to screening for elevated blood pressure in the peripartum period, rehabilitation providers can educate women in healthy lifestyle choices, safe exercise activities, and in management of musculoskeletal disorders that may inhibit physical activity. If you are interested in learning more about caring for women in the peripartum period, look ahead at dates for the continuing education course Care of the Pregnant Patient or Care of the Postpartum Patient