1 Simple Question That Could Improve Women’s Health | Meryam Sugulle | TED

How would you react if I told you that we have an underused screening tool

that has the potential to improve women's health substantially?

And that this tool only consists of one simple question.

Have you had any pregnancy complications?

With that simple question,

we could identify women at increased risk for cardiovascular disease

later in their lives.

That means diseases involving the heart, the brain

and the blood vessels,

like heart attack, heart failure, stroke and high blood pressure.

By asking that simple question,

we could seek out the women

who could benefit from general health screening

already at a younger age.

That means checkups of blood pressure, body weight and blood sugar.

Based on the results, we could offer personalized lifestyle advice

and suggest preventive measures.

Why?

For this is a fact:

cardiovascular disease is a major cause of early death, apart from cancer,

not only for men, but also for women.

I hope that all of you now got very curious

about what on Earth nine months of pregnancy

have to do with older women getting heart attacks and strokes.

Pregnancy is something younger people do, you might think,

even though I would argue that 50 is the new 30.

(Laughter)

Pregnancy is often described by a well-used quote

as a stress test for life.

A woman's health gets tested by being pregnant.

Will she tolerate pregnancy

and all the involved physiological changes well,

or will there be any complications?

The most important organ for pregnancy

is the one that was once attached to the center of your belly,

where your belly button is.

We all have a belly button, regardless of gender.

You and I, King Charles, the Pope, Beyoncé.

And where it is, we were all once connected

via a lifeline, the umbilical cord,

to the most important organ in both our and our mother's life.

You and I, we are all here thanks to our placenta.

We all survived the single most dangerous event in our life,

birth, that is,

due to our well-enough functioning placenta.

We all know that the placenta was our first meal box

when we were growing babies inside our mother's womb.

Most of us also know

that the approximately nine months of growth

inside our mothers' womb

have lifelong, lasting effects

on our health and diseases once we are outside.

But what is lesser-known is that the placenta,

the one we were attached to,

is crucial for the future cardiovascular health of the mother

who lent us a room in her womb.

That means how healthy our placenta was

is very important for the health of our mother's heart and blood vessels.

How is that the case?

How does our placenta

affect our mother's future cardiovascular health?

In order to understand that,

we must briefly talk about the makeup of a healthy placenta.

This fascinating organ is made early on in pregnancy,

when the fertilized egg develops into the baby

and into cells that invade the layers of the womb of the mother.

This happens early on in pregnancy, before the baby even looks like a baby.

After invading the different wall layers of the mother's womb,

the cells group together and form finger-shaped tissue.

These tissue fingers seem to poke into the layers.

Finally, the healthy placenta includes a special room

where these tissue fingers are showered in the mother's blood.

In this shower room,

the growing baby receives different life-important nutrients and signals

via different transport mechanisms.

In other words, it is very important

that everything works well in this specialized room.

It has to be nice and tidy.

That guarantees the meal box effect of the placenta.

The good effect.

But just like almost every other living things,

cells can get stressed, and cells can get out of control.

This happens, for example, in cancer.

But how can a healthy placenta become a stressed placenta?

What happens?

Placental cells can get stressed

when the blood shower in the specialized room gets messy.

The placental cells then get out of control.

They grow crazy bumps on their surface.

In fact, they seem to literally throw up stuff into the specialized room.

By that, the stressed placental cells send many different types of signals

into the specialized room.

And these stress signals then reach the mother's blood

and the mother's blood vessels.

And when they reach the mother's blood vessels,

they can make these vessels unhealthy,

and they can contribute to making the pregnant woman sick,

and the pregnancy gets complicated.

The placenta is then not really healthy anymore.

Maybe you've heard of or even know personally,

women who have had increased blood pressure

from around the middle of pregnancy,

who had protein in their urine or headache,

abdominal pain, blurred vision

or all of this.

Then they had what we call preeclampsia,

a pregnancy complication of varied severity

that occurs in three to 10 percent of all pregnant women,

the rate depending on where we live.

What does preeclampsia have to do with the placenta

and with the mother's future cardiovascular health?

Remember what I told you about the stressed placenta?

According to a widely accepted theory supported by research,

in preeclampsia the stressed placental cells

send signals into the mother's blood.

These stress signals may cause inflammation-like processes

in the inner lining of the mother's blood vessels.

This then leads to disturbed vessel function

and to the signs of preeclampsia that I mentioned earlier.

Preeclampsia is only one of several examples

for a pregnancy complication related to a not-well-working placenta,

but I will stick to this example.

In a way,

the placenta and the mother talk to each other.

And since our earliest cells

formed both us, the babies, and the placenta,

we talked to our mothers even before we could speak properly.

And it turns out that this may well be

one of the more important talks we had with our mothers.

So back to the concept of pregnancy as a stress test for life

and how stressed placental cells

can impact on a mother’s future cardiovascular health,

decades after she was pregnant and had preeclampsia.

How do we know that women after pregnancy complications

are at increased risk for future cardiovascular disease?

In Scandinavia, we have unique access to large population-based data sets

containing health information.

For many decades,

these databases have provided important medical knowledge.

They tell us that women who have had preeclampsia

towards the end of pregnancy

have a doubled risk for future cardiovascular disease,

compared to women who have had uncomplicated pregnancies.

I mentioned the meal box function of the placenta.

I explained the effect of stressed placental cells

and how they send signals to the mother.

If the placenta gets even more stressed,

the meal box function may be affected.

That means the baby has a lower weight than it should have,

in addition to the woman developing preeclampsia.

Some babies may even, for various reasons,

be born too early, prematurely.

For these women

with a very, very stressed placenta,

the databases tell us

that the future cardiovascular disease risk is even higher,

up to four to eightfold higher compared to women with uncomplicated pregnancies.

So to sum up what we have talked about so far,

we have databases that give us information on pregnancy complications

and future cardiovascular health risks.

We know that the baby and the placenta and the mother

send messages to each other, talk to each other during pregnancy,

but we do not know the exact mechanisms

by which complicated pregnancy and the placenta

contribute to future health risks for women.

And this is my point.

Much research remains to be done,

and the placenta is still full of secrets that need to be unveiled.

But why should we bother anyhow?

And how can we identify women at increased risk?

And what should we do then?

As I said in the beginning.

Why? Because cardiovascular diseases

are a main cause for early death also in women.

Heart attacks are known to present differently in women

compared to men,

and may be recognized too late,

and that might prove fatal.

This is also another good reason

for identifying women at increased risk earlier, at a younger age.

This is because the earlier the risk factors are dealt with,

the better the effect on the blood vessels and the heart.

How can we identify women at increased risk?

By asking the right questions about pregnancy at the right time,

and whatever the exact cause and the precise mechanism

for the association between pregnancy complications

and cardiovascular disease prove to be,

our mothers', sisters', aunts' pregnancy history

may provide important information for future health needs.

And what should we do then?

We could take action at the right time.

Women could be offered general health screening at a younger age,

including checkups of blood pressure, body weight and blood sugar.

We could give personalized advice on lifestyle

and try to influence other risk factors,

such as weight gain, obesity,

smoking or type 2 diabetes.

This could be done even before women enter their 50s.

Is this new medical knowledge?

The answer is no.

Has this knowledge been acted upon?

Not really.

Placenta-related pregnancy complications

have officially been acknowledged

as sex-specific risk factors for cardiovascular disease

by the American Heart Association

11 years ago,

and other cardiological societies have followed their lead.

Many guidelines suggest or call for follow-up

after pregnancy complications.

But we are not aware of any country in the world

having a systematic cardiovascular follow-up

for women after pregnancy complications

already at a younger age.

We think such follow-up is of extreme importance

for equality in health care and society's survival,

since women are important for society's survival.

We think that it should be possible to integrate

a simple cardiovascular risk factor assessment --

measure blood pressure, body weight and blood sugar --

at the general practitioners

into existing screening programs for cervical dysplasia

or other comparable available screening programs around the world.

Tomorrow, when you stand in the shower and look at your belly button,

remember the placenta.

Remember the one simple question

that could improve a mother's health.

The one simple question that could improve cardiovascular health.

Have you had any pregnancy complications?

(Applause)