New motherhood and reducing long term risk of cardiovascular disease

When new motherhood should get help from three different kinds of doctors:

The most common risk factors to cause cardiovascular disease (CVD) are the simple seven-smoking, physical inactivity, overweight, diet, blood glucose, cholesterol, and blood pressure.

In pregnant females, added to these risk factors are problems related to pregnancy such as preeclampsia, gestational hypertension, preterm birth, and intrauterine growth restriction, which increase CVD risk several fold and represent an opportunity to identify at-risk women and prevent or reduce future CVD like chronic hypertension and coronary heart disease.

Hence, the months after childbirth in women who have had complicated pregnancies are the period of great opportunity when a close collaboration between obstetricians and cardiologists can prevent or retard future development of CVD in such women.

When does the pediatrician come in?

Breastfeeding is recommended for infant nutrition across the world. According to the American Academy of Pediatrics, babies who are breastfed for at least 6 months are less likely to be overweight, and the duration of breastfeeding is inversely related to the risk of obesity. The incidence of type 2 and type 1 diabetes mellitus are less by 40% and 30% respectively, in breastfed infants. A likely mechanism in the development of type 1 diabetes mellitus is the infant’s exposure to cow milk β-lacto globulin, which stimulates an immune-mediated process cross-reacting with pancreatic β -cells. Additional benefits include boosting the baby’s immune system and lowering the risk for asthma and sudden infant death syndrome.

But those are the benefits for the child. What about the mother?

A large prospective study in nearly 300 000 women in China showed that a history of breastfeeding was associated with a 10% lower risk of CVD later in life. Moreover, each additional 6 months of breastfeeding was associated with a further 3% to 4% lower CVD risk.

The mechanism could be that breastfeeding increases metabolic expenditure by an estimated 480 kcal/d and may enable a more rapid reversal of metabolic changes in pregnancy, including improved insulin sensitivity and lipid metabolism and greater mobilization of fat stores.

Serum triglycerides, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol all increase in the last trimester of pregnancy.

Lactation contributes to rapid reversal of these changes through excretion of triglycerides and cholesterol in milk. In addition, longer breastfeeding duration has been associated with a lower maternal risk of metabolic syndrome, hypertension, and diabetes mellitus later in life.

Besides, a 2019 longitudinal study of more than 100 000 Australian women found that ever breastfeeding was associated with lower maternal risk of CVD hospitalization and mortality compared to never breastfeeding.

Breastfeeding may be especially important for women who develop pregnancy complications such as preeclampsia, because we know that these conditions increase lifetime risk of CVD.

Thus, new motherhood (with pregnancy complications as mentioned) is the sacred place where Pediatricians Obstetricians and Cardiologists should meet. It will help the mother, the baby and the society.