It’s numbers like these that drove Dr. Grayver to help launch Northwell Health’s Cardio-Obstetrics Program in 2020. Now, she’s able to not only identify at-risk patients with an underlying cardiovascular condition in danger of adverse pregnancy outcomes, but to create tailored treatment plans for their health care needs.  

“I catch anywhere between 5-to-10% of those women that do come in with shortness of breath that’s actually not just pregnancy induced, but a sign of something more,” she said.

On a recent episode of the 20-Minute Health Talk podcast, she explained how cardio-obstetrics programs, a relatively new specialty in medicine, are not only catching cardiovascular problems in pregnant women earlier, but the vital role they play in a women’s health before, during and after pregnancy. 

Recognizing the need for a program like this at Northwell, Dr. Grayver, presented the idea of a cardio-obstetrics program to her mentor, Stacey Rosen, MD, senior vice president of the Katz Institute for Women’s Health at Northwell and a national expert on cardiovascular disease. In 2020 they launched Northwell’s cardio-obstetrics program, which Dr. Grayver jokingly calls “my own baby.”  

“Research shows that when the gynecologist asks even as few as three or four additional questions of the women they see for their 'well woman visit' every year, cardiovascular health improves,” Dr. Rosen said. “And with a cardio-obstetrics program in place, that information is easily shared with a cardiologist who specializes in treating pregnant women, like Dr. Grayver at Long Island Jewish Medical Center, as well as Catherine Weinberg, MD, at Lenox Hill Hospital. To optimize women's health, we have to work together across disciplines and this novel model is a shining example of our team-based approach.”   

Something as simple as mild hypertension during pregnancy, Dr. Rosen added, puts a woman in her 20s at much higher risk for cardiovascular disease over the next five to 10 years. By establishing programs that align and integrate these specialties, OB/GYNS and cardiologists get more comfortable asking these questions.   

“Cardiologists and internists should always ask women about their pregnancy history and even about menstrual issues in order to identify important ways to optimize cardiovascular health,” Dr. Rosen said on an earlier episode of Northwell’s podcast. “The heart is a ‘lady-part.’”

Communication between health care providers is always important, and especially so for expecting mothers, says Dr. Grayver; that’s where the field of cardio-obstetrics can make a big difference. Many doctors dismiss the warning signs of cardiovascular disease, even when a woman brings it up. “The old school mentality was, ‘It happens or it’s just a normal part of pregnancy,’” said Dr. Grayver, who also serves as director of Northwell Health’s Women’s Heart program for the Central region. “’The woman delivers, the baby’s good, the mom is good. We keep their blood pressure well controlled within the first week or so and then it’s forgotten.’ We now know that those issues, such as preeclampsia, have lifelong cardiovascular risks.”  

Symptoms of cardiovascular disease that expecting mothers should look out for include: 

• Shortness of breath 
• Swelling of the hands, ankles, and/or face 
• Rapid heartbeat 

Most women adapt to pregnancy just fine. For those who experience these symptoms, Dr. Grayver recommends seeing a cardiologist to get a baseline electrocardiogram (EKG), which is a measurement of the heart’s electrical activity, and echocardiogram, an ultrasound of the heart. This can help rule out significant issues, like cardiomyopathy (a weakening of the heart muscle), valvular disease, or other conditions that may put a woman at risk.  

Pregnancy is like a stress test on the body, Dr. Grayver said. “With a rapid increase in blood volume, your heart rate significantly increases significantly because your heart goes from pumping 5 liters of blood per minute to about eight-to-10 liters of blood per minute. So, that’s a significant strain on the heart.” 

Cardio-obstetrics programs can help diagnose, manage and treat pregnancy complications associated with long-term cardiovascular risk, including: 

• Peripartum cardiomyopathy: a weakening of the heart muscle in the peripartum period, defined as the weeks immediately preceding, during and following childbirth. This disease, which often arises without warning, can be fatal if untreated, especially if the cardiomyopathy results in a significant decrease in the amount of blood the heart sends to the rest of the body.  
• Postpartum preeclampsia: a condition arising in the months following pregnancy, postpartum preeclampsia is a condition characterized by raised blood pressure. The disease disproportionately affects mothers of African-American and/or Hispanic descent and is distinguished from gestational hypertension, another form of obstetrical high blood pressure, by the presence of proteins in the urine (proteinuria), something which only occurs in preeclampsia.  
• Gestational hypertension: a form of pregnancy-onset high blood pressure absent of proteinuria. Gestational hypertension usually resolves upon birth, but must be monitored during pregnancy in the event that complications arise. 
• Growth-restricted pregnancy: a fetus in the 10th percentile of body weight or below. Fetal growth restriction is known to be caused by maternal high blood pressure. It can result in preterm birth at 34 weeks or earlier. 
• Arrhythmias (including supraventricular tachycardia and atrial fibrillation): an abnormal heart rate. Arrhythmias, when caused by and occurring in pregnancy, can signal danger for mother and baby alike. 
• Congenital heart disease: any of a number of hereditary malformations of the heart inheritable by fetuses, including tetralogy of Fallot, transposition of the great arteries, and bicuspid aortic valves. These conditions, which often go undetected, can be caught by cardiologists.  
• Coronary artery disease: an inability of the coronary arteries to supply blood to the heart, resulting in insufficient blood flow. Pre-existing coronary artery disease alone makes pregnancies high-risk, due to the danger of mother and/or fetus receiving insufficient amounts of blood.
• Rheumatic heart disease including mitral stenosis and aortic stenosis: autoimmune cardiac disease caused by inflammatory damage to the heart, typically in response to strep throat or scarlet fever. The heart’s valves may weaken and fail. 

Preparations to ensure a healthy pregnancy should be made well before conception, Dr. Grayver said. Adopting healthy dietary and exercise habits, she advises, is of paramount importance — and not just for a week or two.  

“Many people have this notion that dieting is a two-to-four-week situational treatment,” she explains. “Instead, I recommend a comprehensive, sustained lifestyle modification centered around a plant-based diet and accompanied by moderate exercise — at least 30 minutes a day, at least five days a week.”