Lee Health Cardio-Obstetrics : A New Approach to Heart Health During Pregnancy

Cardiologist Dr. Kelly Costopoulos specializes in caring for women with cardiovascular disease in pregnancy and post-partum at the Lee Health Heart Institute’s new cardio-obstetrics program. 

The physiological changes of pregnancy can place increased stress on a woman's heart and vascular systems. For most women, these changes pose no issues, but for some, pregnancy can unmask or worsen heart conditions. 

According to cardiologist Dr. Kelly Costopoulos, addressing cardiovascular problems early in pregnancy, combined with ongoing management and monitoring, greatly improves the chances of a smoother pregnancy and healthier outcomes for both mother and baby.

“Health conditions like hypertension (high blood pressure) and preeclampsia can lead to long-term health problems if early intervention is delayed or unmanaged,” she says. “The goal is to prevent complications before, during, and after pregnancy while providing education and ongoing support for mothers and their babies.”

Dr. Costopoulos specializes in caring for women with cardiovascular disease in pregnancy and post-partum at the Lee Health Heart Institute’s new cardio-obstetrics program.

To learn more about this specialized field of medicine, Healthy News spoke with Dr. Costopoulos, who recently joined Lee Health and brings her expertise in cardio-obstetrics.

Q: What are your board certifications?

 Dr. Costopoulos: I have board certifications in internal medicine, cardiovascular disease, echocardiography and cardiovascular magnetic resonance.

I have general cardiology training like any other cardiologist, but I have advanced training in cardiovascular disease in pregnancy and postpartum. My goal is to improve maternal health by providing pre-conception counseling for patients with cardiovascular disease, helping to manage cardiac conditions during pregnancy, and working to reduce long-term cardiovascular risk in those who develop cardiovascular disease in pregnancy.

 Q: What types of patients do you see in your practice?

 Dr. Costopoulos: About half my practice is general cardiology, and the other half is dedicated to cardio-obstetrics. I see women at all stages of their reproductive journey: those seeking preconception counseling, women who develop cardiac issues during pregnancy, and those experiencing cardiovascular problems postpartum.

Q: What conditions might qualify someone for preconception cardiac counseling?

 Dr. Costopoulos: The experts at the cardio-obstetrics program provide counseling for women with underlying heart disease, including those who have a history of heart failure or valve disease. For women with existing heart disease or cardiovascular risk factors, our team helps plan for pregnancy, ensuring the health of both the mother and fetus.

Our specialized care also benefits women with a family history of heart disease, or who have experienced blood clots or pulmonary embolism, a history of preeclampsia or hypertensive disorders during in pregnancies.

Q: How common are these preexisting cardiac conditions in women of childbearing age?

 Dr. Costopoulos: They're relatively rare compared to the general population of women in the same age group. Most young women don't have structural heart problems, but for those who do, specialized care is crucial during pregnancy, which puts a higher stress load on the heart. The heart pumps about 1.5 times the normal non-pregnant workload, and the body retains more fluid. This additional stress can unmask problems that women already had but weren't aware of, such as leaky heart valves or narrowed heart valves.

The most common cardiac issues we see developing during pregnancy are hypertensive disorders like gestational hypertension and preeclampsia.

 Q: Can you explain preeclampsia in simple terms?

 Dr. Costopoulos: Preeclampsia is a serious pregnancy complication characterized by high blood pressure and other organ damage, potentially leading to severe complications for both mother and baby. 

It typically presents as high blood pressure developing in the second half of pregnancy or in the early postpartum period. It stems from a problem with the blood vessels but can lead to more serious complications like damage to the kidneys, liver, or even strokes. That's why it's important to recognize preeclampsia early and promptly treat it. 

About 5 percent of pregnancies are affected by preeclampsia, making it significantly more common than structural heart disease during pregnancy.

Q: This month is Preeclampsia Awareness Month. Why is raising awareness so important?

Dr. Costopoulos: We've learned that women who develop preeclampsia are at higher risk for heart disease, stroke, and heart attacks decades later compared to women who don't experience preeclampsia during pregnancy. Whether this is due to damage that occurs during pregnancy or an underlying vascular dysfunction they're predisposed to, we're not entirely sure.

Because of this increased risk, we try to identify these women early—when they're young and in their childbearing years—to provide education and screen them for conditions like high cholesterol and diabetes. Our goal is to educate them about ways to reduce their risk of developing cardiovascular disease later in life.

Raising awareness about preeclampsia is crucial to improving maternal and infant health outcomes. Raising awareness focuses on educating pregnant women and healthcare providers about the signs, symptoms, risk factors, and available prevention and treatment options.

WATCH HEALTH MATTERS: Keeping the risk of preeclampsia in check with remote patient monitoring 

Q: How does cardiac imaging factor into your practice?

 Dr. Costopoulos: Echocardiography is our workhorse imaging tool, especially for pregnant patients. There's no radiation, making it safe during pregnancy, and it provides valuable information about heart function, valves, and any congenital heart problems. It's highly accessible, relatively quick, and easy to perform.

That said, not every patient needs an echocardiogram. We order them when we suspect structural heart problems like heart failure, leaky heart valves, or a thickened heart muscle. For many women with symptoms like palpitations and shortness of breath (which can be normal during pregnancy), we often start with a BNP blood test, or brain natriuretic peptide screen, to screen for heart failure. 

A BNP blood test measures the level of a protein produced by the heart and blood vessels. Elevated BNP levels are often associated with heart failure, although other conditions can also cause high readings. The test helps us determine if symptoms like shortness of breath are due to heart failure or other causes. If that comes back abnormal, then we typically proceed with an echocardiogram.

Q: What's the difference between a cardiac MRI and an echocardiogram?

Dr. Costopoulos: An MRI is a more involved test where the patient lies in a scanner for about 45-60 minutes. Like echocardiography, it doesn't use radiation, so it's safe during pregnancy if necessary—though we rarely need to perform it while women are pregnant.

MRI provides more detailed information about the heart muscle, including any scarring or inflammation, and gives precise measurements of valve function and heart chambers. It's essentially a more detailed imaging tool than an echocardiogram.

Q: What kind of care does the cardio-obstetrics program provide after the baby is born?

Dr. Costopoulos: Cardiovascular health doesn’t end at delivery: The postpartum period is a time when complications such as high blood pressure or heart failure can emerge. We check up on them regularly—with visits, remote monitoring, and, if necessary, order additional tests like echocardiograms. Through detailed education, patients learn to identify warning signs and understand the importance of seeking immediate medical attention. Understanding long-term risks can help women make appropriate lifestyle changes to reduce those risks.       

Q: What’s the takeaway message for women who are considering getting pregnant?

Dr. Costopoulos: If you know that you have a cardiac condition and are considering getting pregnant, speak with your healthcare team and consider a referral to Lee Health’s cardio-obstetrics program to reduce your risks. 

The program is unique because it brings together experts and specialists in various areas like heart rhythm disorders, congenital heart disease, and general cardiology. We can address all aspects of a patient's heart health through this collaboration before, during, and after their pregnancy.

WATCH HEALTH MATTERS: Dr. Costopoulos discusses cardio-obstetrics

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