Pregnancy Has Risks. Without ‘Roe,’ More People Will Face Them

Florio recovered. Today, she is back to her triathlete workouts, and her 8-year-old son is healthy. But her heart still sometimes races — something it had not done before, and a harbinger of cardiac issues she might have in her future. “The heart never really goes back to normal,” she says. She decided not to have another child because of the increased risks she would face.

Her state, Missouri, has a trigger law that will go into effect if Roe is struck down, banning all abortions “Except in cases of medical emergency.” Legally, it would be up to the physician or health provider to prove that a person is facing an emergency. Twelve other states have trigger laws that would ban or limit abortion access and five have pre-Roe bans that would go into effect if Roe is overturned. Some remove consideration of the health of the motherand certain “no exception”Bans force women to continue pregnancies after rape or incest, or block terminations even in the event of miscarriage.

In states with strict anti-abortion laws, delayed care could create a new type of pregnancy risk. An analysis by researchers at the Washington University in St. Louis found that states with the most restrictive abortion laws from 2009 to 2017 had higher rates of maternal mortality. The study wasn’t designed to identify a cause, but the authors speculated on possible reasons: Less restrictive states might offer more resources to support women’s health. Or in more restrictive states people with high-risk pregnancies that they can’t terminate may be more likely to die from complications.

Even before the draft US Supreme Court opinion that would gut Roe became public, medical experts have been raising an alarm about a rise in cardiovascular complications. Pregnancy is often called “nature’s stress test”Because the physical strain can reveal heart-related conditions that have long-term implications. In 2021, a Lancet commission on women and cardiovascular disease pointed to many under-recognized risks, including of peripartum cardiomyopathy, a form of heart failure that occurs in late pregnancy or postpartum. The American Heart Association has used its “Go Red for Women”Campaign to publicize that“ heart disease is the No. 1 killer of new moms. ”

Stroke can come on suddenly and unpredictably. Some people have rising blood pressure after delivery, which creates a silent danger at a time when women are less likely to be following up on their medical care. (And they may have lost insurance; 12 states have taken no action to expand Medicaid to cover the postpartum year, despite federal incentives.)

Affecting about 45 per 100,000 pregnant or postpartum women, stroke is not common — but it is not exceedingly rare, either. About half of the cases result in permanent debilitation. “It can be devastating,” says Louise D. McCullough, a stroke expert and chief of neurology at Memorial Hermann Hospital in Houston. “These are young women. If they’re disabled or die, it has a huge impact on the family. ”

One recent case resonates for McCullough: A 26-year-old woman with an uneventful first pregnancy developed a severe headache a few weeks after childbirth. By the time she arrived at the hospital, she had a massive brain hemorrhage from a clot, known as cerebral vein thrombosis. Clot-busting treatment temporarily saved her life, but she died of complications a few months later. Monitoring blood pressure, even postpartum, and acting fast when a problem arises can make a life-altering difference, McCullough says. “It’s important to recognize that pregnancy can be a dangerous time for women,” she says.

Why does pregnancy so often trigger serious health conditions? To get some insights into cardiovascular effects, the nuMoM2b study is following about 4,500 mothers for years beyond their pregnancies. Conducted at eight medical centers around the US and funded by the National Institutes of Health, the study focuses on the relationship between “adverse pregnancy outcomes,” such as gestational hypertension or preterm birth, and mother’s future cardiovascular health. (The concept is similar to the famous Framingham Heart Studywhich has been running since 1948 and led to new understandings of cardiovascular risks.) So far, researchers have found key markers in the first trimester that may be predictive — higher triglycerides, high-sensitivity C-reactive protein, and blood glucose were associated with hypertension two to seven years after delivery.

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