Seven weeks before the birth of her second son, Daniel, Amanda Perez posed for a family portrait with her husband, Luis, and her son Lucas.
Courtesy of Amanda Perez
Lying in bed, exhausted, inside her Bronx apartment, Amanda Perez, now 31, spent most of her first pregnancy hoping things “did not go south.” Though she had quit a stressful job at an animal hospital to start a family with her husband, Luis, her high blood pressure—neglected and untreated during the pandemic—put her at risk for serious complications. “I watched myself very carefully,” recalls Perez, “hoping every headache wasn’t a bad sign.”
But in March 2022, at 28 weeks, Perez was diagnosed with preeclampsia, a blood pressure disorder of pregnancy that can lead to damage to the liver and kidneys. Preeclampsia, which has no known treatments, is a leading cause of maternal and infant illness and death. Fortunately, Perez’s blood pressure stabilized. Christina Penfield, MD, MPH, assistant professor of obstetrics and gynecology, and a member of the maternal–fetal medicine team, recommended delivery at 37 weeks, and on May 15, after an induced labor, Perez gave birth to a healthy baby boy, Lucas, at ٺƵ’s Tisch Hospital.
A generation ago, Perez’s delivery would have been considered a “cure” for preeclampsia, and medical attention would have shifted to the baby. But a recent stream of research has raised awareness that pregnant and postpartum patients with preeclampsia are prone to continued high blood pressure for as long as 12 months after birth. Moreover, the 10 to 15 percent of pregnant people who experience pregnancy complications—preterm births, gestational diabetes, and hypertensive disorders like Perez’s—are significantly more likely to develop long-term cardiovascular disease, including strokes or heart attacks, than those who don’t. In short, complications during pregnancy are now considered a warning sign of future health threats.
Concerned, Perez consulted her cardiologist, Adam Small, MD, an assistant professor of medicine at NYU Grossman School of Medicine, about a long-term care plan. Dr. Small, who specializes in adult congenital heart disease, referred her to colleagues who were starting up a new program at ٺƵ: the Postpartum Cardiovascular Health Program. A collaboration between experts in cardiology and maternal–fetal medicine, the program—based on a subspecialty of cardiology known as cardio-obstetrics—uses early detection, prevention, and treatment strategies to care for pregnant patients deemed vulnerable to cardiovascular disease. Perez signed up, becoming one of the program’s first participants.
Jeffrey S. Berger, MD, director of the Center for the Prevention of Cardiovascular Disease, believes the burgeoning program could prevent “a considerable percentage” of future strokes and heart disease. “I am confident that by initiating early prevention measures—a thorough cardiac exam at three months postpartum and a comprehensive plan for optimizing health—we can save a lot of lives,” he says.
Another goal is to gain a deeper understanding of how and why hypertensive complications arise during pregnancy, and how to prevent them. The program’s leaders—Dr. Berger, Dr. Penfield, and cardiologist Anais Hausvater, MD, a clinical instructor of medicine—are studying blood platelet function in pregnancies at risk of preeclampsia to establish biomarkers that may one day lead to targeted preventive therapies. “What distinguishes our program is the combination of our maternal–fetal medicine team’s expertise in hypertensive disorders of pregnancy and postpartum care with the expertise of leaders in the field of preventive cardiology,” says Dr. Penfield, a co-director of the program.
Several months after her delivery, Perez met with Dr. Hausvater, also a co-director of the program, who adjusted Perez’s medication dosage to stabilize her blood pressure and recommended steps to improve her overall health before she attempted to conceive again. After consulting with nutritionist Heather A. Hodson, RDN, CDN, CDCES, Perez cut down on red meat, swapped packaged cereal for oatmeal and fruit, and reduced her sodium intake by prioritizing minimally processed foods. “A health scare like a traumatic pregnancy and labor experience can be a time of peak motivation for behavioral changes,” Dr. Hausvater explains. As Lucas grew into a climbing and leaping daredevil, Perez increased her daily steps naturally in the process of keeping up with him.
After returning from a vacation last summer, Perez learned she was pregnant again. She was excited but nervous, as the possibility of a preeclampsia recurrence remained high. As a precaution, Dr. Hausvater advised her to take a preventive daily aspirin. She also reassured Perez that according to research, her lifestyle changes had reduced the likelihood of complications.
Perez welcomed her second son, Daniel, on March 19, 2024. She says that throughout her second pregnancy, she felt surprisingly energetic and has her doctors to thank for it. “Because of the care my doctors provided after I gave birth for the first time,” she says, “this time around has been so much better.”
