Marian Smith was ecstatic when she found out she was pregnant in the summer of 2021. But just eight weeks into the pregnancy, her excitement turned to uncertainty when she started having unusual symptoms.
Smith, 34, who had run half marathons and was a yoga instructor, felt extreme shortness of breath from walking. “At first, I thought this was part of the pregnancy journey, although shortness of breath was a symptom I had expected much later on,” she said.
During a prenatal ultrasound near her home in Stamford, Connecticut, the sonographer noticed Smith’s breathing difficulty and suggested she see a cardiologist. Smith heeded the advice. At one of her cardiology appointments, her oxygen saturation—the amount of oxygen circulating in the blood—was so low that she was sent to the emergency department and then hospitalized. Prolonged periods of low oxygen in pregnancy can affect organ function in the mother and the growth of the baby.
“My doctors had the hardest time figuring out what was wrong,” Smith said. “I was pretty scared about my health and my baby’s health.” Smith said she also felt vulnerable as a Black woman and expectant mom.
Navigating Disparities in Pregnancy Care for Black Women
Black women are three times as likely to die from a pregnancy complication than White women, according to the Centers for Disease Control and Prevention, for multiple reasons including underlying chronic conditions. While her doctors were trying to pinpoint a diagnosis, Smith thought about this reality “every single day.”
“Reading news reports about these disparities is one thing, but living the experience is another,” Smith said.
Because Smith did not have a history of heart disease, she struggled to find a cardiologist who would see her right away. Once she did, she was grateful for the nurse practitioner, also a Black woman, who Smith sensed had an innate understanding of her concerns. “She took me, and my health concerns, seriously,” said Smith. “She made sure I was comfortable and that I received the care I needed.”
That care included heart imaging that suggested she may have a congenital heart condition called a patent foramen ovale (PFO), or a hole in the heart. Smith needed an expert in complex cardiac anomalies. She was referred to Dan G. Halpern, MD, director of the Adult Congenital Heart Disease Program, part of NYU Langone Heart.
Confirming a Diagnosis with NYU Langone Specialists
Dr. Halpern reviewed Smith’s imaging results and then saw her at NYU Langone’s Congenital Heart Center, where he observed her oxygen saturation drop after walking. He confirmed a PFO diagnosis and quickly moved forward with creating a care plan.
PFO is present in everyone before birth as a naturally occurring flap that allows blood to flow between the heart’s left and right upper chambers. Typically, the PFO closes soon after birth. In about 25 percent of people, the hole remains open to a certain extent. Most won’t have symptoms or need treatment, but for some people, a PFO increases the risk of stroke and drops in oxygen level in the blood. In pregnancy, hormones can further exacerbate the risks of blood clotting. Clotting that occurs during pregnancy can travel through a PFO and increase the chance of stroke.
“As soon as I met Dr. Halpern, I could tell he wanted the best for my health and the best for my baby,” Smith said. “He was so compassionate. I was relieved to be in his team’s care.”
Developing a Care Plan for Both Mother and Baby
Dr. Halpern conferred with his NYU Langone colleagues in maternal–fetal medicine and cardiology. “We had a concern about how Marian could physically deliver a baby when her oxygen saturation was so low,” Dr. Halpern said. “And, with pregnancy, there’s an increased risk of blood clots. If a clot occurs in a person who has a PFO, stroke risk increases.”
Her care team decided that a minimally invasive catheter-based procedure to correct the PFO should be scheduled for the 18th week of pregnancy, when the baby’s organs are formed. By this point in the pregnancy, anesthesia and X-ray imaging present less of a risk to the developing fetus.
“This was a complex case, given that we had two patients to consider,” said interventional cardiologist Michael Argilla, MD. “Minimizing risks to both the mother and the developing fetus required a team effort and additional planning.”
To correct the defect, he and his colleague Sunil Saharan, MD, threaded a catheter through a vein at the top of Smith’s leg and up to the location of the hole in her heart. They then placed a closure device in the hole, correcting the blood flow through the two upper heart chambers and allowing for proper oxygenation. Heart tissue later grows over the device, further helping to seal the hole.
To ensure the health of mother and baby during the procedure, maternal–fetal medicine specialist Meghana Limaye, MD, provided close monitoring with a pre- and post-procedure ultrasound and then saw her in the hospital the day after to check on her recovery.
Smith felt better immediately after the procedure—her oxygen levels normalized, and she was no longer short of breath. “I felt like I was thriving and that my baby was thriving,” she said.
Ensuring a Safe Delivery
NYU Langone’s maternal–fetal medicine team continued to see Smith through the remainder of her pregnancy and during labor and delivery. “Having a heart procedure is quite unusual in pregnancy,” Dr. Limaye said, adding that blood clotting continued to be a concern and that Smith needed to take anticoagulants until after delivery. “Our specialists wanted to make sure that Marian received the best obstetric care possible.”
On April 8, 2022, at 39 weeks, Smith was induced for delivery. Maternal–fetal medicine specialists closely monitored her for a rapid or irregular heartbeat. She delivered vaginally with no complications, and she and her husband welcomed a healthy baby boy, Idenara Abu.
Today, Smith is flourishing as a busy mom and is gradually returning to running and working out. As part of her follow-up care, she will visit Dr. Halpern about once a year so he can monitor the durability of the tissue repair in the heart.
Looking back on her experience, Smith encourages other women to listen to their bodies and to advocate for their health. “Being a woman of color, I knew it could be an uphill battle,” she said. “But when you feel like something’s wrong, especially when you’re pregnant, speak up and seek the help that you need.”