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Health

Complications during pregnancy linked to a higher risk of heart disease, study finds

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CNN
 — 

Five major pregnancy complications are strong lifelong risk factors for ischemic heart disease, a new study finds, with the greatest risk coming in the decade after delivery.

Ischemic heart disease refers to heart problems, including heart attack, caused by narrowed or dysfunctional blood vessels that reduce blood and oxygen flow to the heart.

Gestational diabetes and preeclampsia increased the risk of ischemic heart disease in the study by 54% and 30%, respectively, while other high blood pressure disorders during pregnancy doubled the risk. Delivering a baby early – before 37 weeks – or delivering a baby with a low birth weight were associated with a 72% and 10% increased risk, respectively.

The study, published in Wednesday in the BMJ, followed a cohort of more than 2 million women in Sweden with no history of heart disease who gave birth to single live infants between 1973 and 2015.

Roughly 30% of the women had at least one adverse pregnancy outcome. Those who had multiple adverse outcomes – whether in the same or different pregnancies – showed further increased risk of ischemic heart disease.

“These pregnancy outcomes are early signals for future risk of heart disease and can help identify high-risk women earlier and enable earlier interventions to improve their long-term outcomes and help prevent the development of heart disease in these women,” said Dr. Casey Crump, an author of the study and professor of family medicine at the Icahn School of Medicine at Mount Sinai.

Heart disease is the leading cause of death among women in the United States and accounts for 1 in 5 female deaths, according to the US Centers for Disease Control and Prevention. This research adds to mounting evidence that pregnancy provides important information about a woman’s cardiovascular health.

“What happens to a woman during pregnancy is almost like a stress test or a marker for her future cardiovascular risk after pregnancy. And unfortunately, a lot of women don’t get told this by anybody,” said CNN Medical Correspondent Dr. Tara Narula, an associate professor of cardiology and the associate director of the Women’s Heart Program at Lenox Hill Hospital. She was not involved in the new study.

Although it’s not completely clear why, experts say the normal changes that occur during pregnancy may unmask underlying health issues in some women with certain risk factors.

Experiencing an adverse pregnancy outcome – even temporarily – could result in changes to blood vessels and the heart that may persist or progress after delivery, increasing a woman’s risk for cardiovascular disease.

This heightened risk is a particular concern for women in the US, experts say, where the maternal mortality rate is several times higher than in other high-income countries.

“There’s been a change in the birthing population. US women are getting pregnant at a later age, and they have already accrued maybe one or two cardiovascular risk factors. Perhaps there are other stressors in life – depression, stress, isolation, obesity – lots of different things that are impacting women in the US,” said Dr. Garima Sharma, associate professor of cardiology and director of the Cardio-Obstetrics Program at Johns Hopkins University School of Medicine, who also was not involved in the new study.

Pregnancy complications are carefully monitored during pregnancy, but there is little evaluation of and education about the effects on cardiovascular health after delivery for women, experts say.

“And so they have their delivery, they’ve had maybe preeclampsia or gestational diabetes, and nobody really follows up with them. They are not told that, in fact, they are at increased risk,” Narula said.

Gestational diabetes is a marker not only for increased risk of diabetes but also for general cardiovascular disease. Preeclampsia and eclampsia are markers for hypertension risk as well as general cardiovascular risks.

Narula, a cardiologist who specializes in caring for women, regularly considers adverse pregnancy outcomes when evaluating patients and emphasizes the continued need for this.

“The classic risk calculator that we use doesn’t have anything in there for pregnancy complications, but you know, it should for women, and hopefully someday, they will start to take that into account,” she said.

The American Heart Association recommends that all health care professionals take a detailed history of pregnancy complications when assessing a woman’s heart disease risk, but this is not consistently done in clinical practice, especially in primary care, where most women are seen, Crump says.

“Raising awareness of these findings among physicians as well as women hopefully will enable more of these women to be screened early and hopefully improve their long-term outcomes,” he said.

Roughly 1 in 3 women will have an adverse pregnancy outcome. Experts say that improving your health before getting pregnant can help avoid these issues.

“Reducing your risk should start preconception, and so getting your body and yourself into the healthiest state possible before you ever even get pregnant is really the first step,” Narula said.

This includes achieving and maintaining a healthy body weight with a good diet and regular exercise, controlling high blood pressure and diabetes, quitting smoking and managing stress.

Taking action after pregnancy is equally important, as research has estimated that only 30% to 80% of women have a postpartum checkup 6 to 8 weeks after delivery.

“Making sure that these women actually are appropriately followed after their delivery and that there is a warm handoff between [obstetrics] and [maternal-fetal medicine] to their primary care doctors or preventive cardiologists who can then talk about optimizing cardiovascular risks and reduction of these risk factors post-pregnancy in the postpartum time frame is crucial,” Sharma said.

Experts hope that increased patient and provider awareness of the connection between pregnancy and heart health will keep birth from being a cause of death.

“Cardiovascular disease is preventable. It’s a leading cause of maternal mortality, but it doesn’t have to be. If we do a better job at screening patients before they get pregnant, if we do a better job of treating them during pregnancy and postpartum, we can improve women’s outcomes,” Narula said. “It’s a tragedy to bring a new life into the world, and then the mother suffers some horrible complication and/or death that could have been prevented.”

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Health

Large new review underscores the risks of Covid-19 during pregnancy

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CNN
 — 

Pregnant women and their developing babies are at higher risk for severe outcomes if they get Covid-19, and now a large, international review is helping to underscore how devastating those risks can be.

The study draws on data from 12 studies from as many countries—including the United States. Altogether, the studies included more than 13,000 pregnant women—about 2,000 who had a confirmed or probable case of Covid-19. The health outcomes for these women and their babies were compared to about 11,000 pregnancies where the mother tested negative for Covid-19 or antibodies to it at the time of their deliveries.

Across the studies about 3% of pregnant women with Covid-19 needed intensive care, and about 4% needed any kind of critical care, but this was far higher than the numbers of pregnant women who needed that kind of care outside of a Covid-19 infection.

Compared to pregnant individuals who weren’t infected, those who got Covid-19 were nearly 4 times more likely to be admitted to an intensive care unit. They were 15 times more likely to be ventilated and were 7 times more likely to die. They also had higher risks for pre-eclampisa, blood clots, and problems caused by high blood pressure. Babies born to moms who had Covid-19 were at higher risk for preterm birth and low birth weights.

Previous studies have suggested that Covid-19 may increase the risk of stillbirth, but this study didn’t find that same link.

Still, the findings paint a clear picture that shows the risks of pregnancy are amplified by Covid-19 infections.

“It’s very clear and even it’s consistent, you know, whether we’re talking about Sweden where we have really generally great pregnancy outcomes to other countries that you know, have bigger problems with maternal morbidity and mortality, that having COVID and pregnancy increases risk for both mom and baby,” said lead study author Emily Smith, who is an assistant professor of global health at George Washington University.

The study has some caveats that may limit how applicable the findings are to pregnant individuals in the Omicron era.

First, the studies were conducted relatively early in the pandemic, at a time when most people were still unvaccinated and uninfected. That means people in the study were likely at higher risk not just because they were pregnant, but also because they were immunologically naïve to the virus—they didn’t have any pre-existing immunity to help them fight off their infections.

Since then, many pregnant individuals have gotten vaccinated, or had Covid-19 or both. As of the first week of January, about 72% of pregnant people in the U.S. have had their primary series of Covid-19 vaccines, and about 95% of Americans are estimated to have had Covid-19 at least once, or been vaccinated against it, according to data from the Centers for Disease Control and Prevention. That means it’s likely they have some immune memory against the virus that may help protect against severe outcomes.

That immune memory appears to fade over time, however. CDC data show just 19% of pregnant women have had an updated booster, meaning many people may not have as much protection against the virus as they think they do.

Lead study author Emily Smith, who is an assistant professor of global health at George Washington University, says the study results reflect the risk of Covid-19 and pregnancy in unvaccinated people.

Unfortunately, Smith says, many countries still don’t have clear guidelines advising vaccination during pregnancy. And there are some parts of the world, such as China, that still have substantial proportions of their population who’ve never been been infected.

For people who are trying to weigh the risks and benefits of Covid-19 vaccination during pregnancy, Smith says this study helps tip the scales firmly on the side of vaccination.

“It’s worth it to protect yourself in pregnancy,” Smith said.

She says this study didn’t look at the benefits of vaccination in pregnancy, but other studies have, showing big decreases in the risk of stillbirth, preterm birth and severe disease or death for mom.

“And so that’s kind of the complementary story,” said Smith.

Dr. Justin Lappen, division director of Maternal Fetal Medicine at the Cleveland Clinic, praised the study and said its findings reinforce and advance previous research, which has found that Covid-19 markedly increases the risk of severe outcomes for mom and baby. He wasn’t involved in the study.

He says the findings highlight the importance of preventing and treating Covid-19 in pregnant women.

Therapies that are indicated or otherwise recommended should not be withheld specifically due to pregnancy or breastfeeding, Lappen wrote in an email to CNN.

The study is published in the journal BMJ Global Health.

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Entertainment

Sharon Osbourne reveals daughter Kelly has welcomed her first child

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CNN
 — 

Sharon Osbourne revealed that her daughter Kelly Osbourne has quietly welcomed a baby, her first, with her boyfriend, Sid Wilson.

Osbourne and the Slipknot DJ are new parents to a baby boy named Sidney, her mom announced during an appearance on Britain’s “The Talk” on Tuesday.

“So great, so great. She won’t let a picture go out of him, and I’m so proud of her,” Osbourne said of her daughter.

Kelly Osbourne first shared publicly she was pregnant last May with a sonogram pic on Instagram.

“I know that I have been very quiet these past few months so I thought I would share with you all as to why,” she wrote at the time. “I am over the moon to announce that I am going to be a Mumma.”

In November, she said on her Instagram Stories, “Okay, here we go,” with no other information.

The new baby makes five grandchildren for Ozzy Osbourne and Sharon.



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Science

Fossil site was birthing ground for giant marine reptiles, study reveals

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CNN
 — 

The final resting place for dozens of massive prehistoric marine reptiles lies in what’s now Nevada’s Humboldt-Toiyabe National Forest.

But why the ichthyosaurs died in such large numbers at this one particular fossil site some 230 million years ago has long been a source of debate among paleontologists. Scientifically known as Shonisaurus popularis, the species resembled a chunky dolphin and grew at least 50 feet (15.2 meters) long.

Theories suggested a mass stranding event or that the ichthyosaurs were poisoned by toxins from an algal bloom.

Now, though, scientists say that they have ruled out these hypotheses and have a much better understanding of why 37 of the ancient creatures died at the same location. The researchers believe their findings illuminate a fascinating aspect of the reptile species reproductive behavior, which is shared by some of today’s marine mammals.

“We present evidence that these ichthyosaurs died here in large numbers because they were migrating to this area to give birth for many generations across hundreds of thousands of years,” said study coauthor Nicholas Pyenson, a research geologist and curator at the Smithsonian National Museum of Natural History in Washington, DC, in a news release.

“That means this type of behavior we observe today in whales has been around for more than 200 million years.”

Present-day whale species, including blue and humpback whales, routinely migrate across oceans to breed and give birth in waters where predators are scarce. Many whales congregate year after year along the same stretches of coastline.

“There are other examples of ichthyosaur embryos and newborns, but this is the first time we have strong evidence for reproductive grouping behavior,” said study coauthor Randy Irmis, chief curator and curator of paleontology at the Natural History Museum of Utah in Salt Lake City.

“We know this is something many large marine vertebrates exhibit in the present, so it makes sense that simialr behavior occurred in the past. But we really didn’t know how far back, especially with extinct animal groups like ichthyosaurs, that have no close living relatives,” Irmis said in an email to CNN.

The researchers from the United States, United Kingdom and Belgium used new techniques, such as 3D modeling, to investigate the fossil site, which is part of Berlin-Ichthyosaur State Park.

The team examined the chemical makeup of rocks surrounding the fossils and found no evidence of any sudden increases in organic matter, such as algae, that might have starved the creatures of oxygen.

Geological evidence also suggested the ichthyosaurs’ bones had sunk to the bottom of the sea, which then covered much of present-day Nevada, rather than along a shoreline shallow enough to suggest the marine reptiles had beached themselves.

What’s more, the team noticed the fossils were predominantly of adult ichthyosaurs, with very few other marine vertebrates present. Nor were there any juvenile ichthyosaurs.

A breakthrough came when tiny ichthyosaur remains were identified among both new fossils collected at the site and within older museum collections. Micro-CT X-ray scans revealed the small bones belonged to embryonic and newborn ichthyosaurs.

“Once it became clear that there was nothing for them to eat here, and there were large adult Shonisaurus along with embryos and newborns but no juveniles, we started to seriously consider whether this might have been a birthing ground,” said lead author Neil Kelley, a research assistant professor in Earth and environmental sciences at Vanderbilt University in Nashville, Tennessee, in the news release.

The authors concluded that the area must have been a preferred birthing habitat for the prehistoric creatures — and that the high number of fossilized remains was a result of the high numbers of ichthyosaurs that congregated there, perhaps over millions of years, to give birth.

“This is a clear ecological signal, we argue, that this was a place that Shonisaurus used to give birth, very similar to today’s whales. Now we have evidence that this sort of behavior is 230 million years old,” Pyenson said.

The journal Current Biology published the research on Monday.

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