Dear Rachel:

Thank you for bringing yet another condition to our attention.

Breastfeeding is associated with a lower risk of cardiovascular disease,
including stroke. (AHRQ 2018)

Pregnancy leads to a blood volume increase of over a quart, and seems to be
more stressful on the cardiovascular system than lactation would be.

I went searching and found some good news; however the sample is 23 women
with 32 pregnancies.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770944#:~:text=Conclusions%20and%20Relevance%20This%20study,who%20did%20not%20experience%20pregnancy
.

*Conclusions and Relevance*  This study found that most women tolerated
pregnancy and lactation after SCAD without evidence for increased risk of
SCAD recurrence when compared with women with a history of SCAD who did not
experience pregnancy. Although this study is reassuring and indicates
complex contributors to SCAD recurrence, the results need to be interpreted
prudently because of study selection bias and the small total number of
women who became pregnant after SCAD. The notable hemodynamic changes that
occur with pregnancy and severe presentation of pregnancy-associated SCAD
are reasons for concern when considering pregnancy after SCAD.

Here's another way of reporting on the above study.

https://www.tctmd.com/news/women-prior-scad-not-always-risk-recurrence-pregnancy

Among the 23 women who became pregnant post-SCAD, who had a total of 32
pregnancies among them, the median time to conception was 18 months after
their first SCAD. Their median age was 38, and 87% were white. Nearly
two-thirds of the pregnancies resulted in live births, and 75% chose and
were able to breastfeed their babies (median 4.8 months).--


Here's a report of 13 cases:

https://academic.oup.com/ehjcimaging/article/18/1/54/2890542

Pregnancy seems to be the greatest risk, and breastfeeding is mentioned in
this study as a
"In the present study, only one case of breastfeeding could be potentially
linked to P-SCAD. "

"Compared with earlier reports, SCAD is more prevalent than previously
believed,1,4,22 and it is the most common cause of pregnancy-associated
myocardial infarction.7 Changes in the last trimester of pregnancy and the
puerperal period are possible pathophysiological mechanisms. With increased
levels of serum progesterone and estrogen, the synthesis of collagen is
impaired with loss of normal structure of the elastic fibres in the media
layer of the artery, as well as coagulation changes resulting in a
pro-thrombotic state.8 Estrogen has also been shown to enhance release of
matrix metalloproteinase,23 which can lead to cystic medial necrosis and a
lack of structural support of the vasa vasorum in the media–adventitia
border. A weakened vasa vasorum may rupture as a result of the increased
haemodynamic stress of pregnancy or labour, leading to an intramural
haematoma or intimal disruption.7 Notably, pregnancy physiologic changes
may take up to 6 months to return to the non-pregnancy state."

warmly,
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC, RYT
www.nikkileehealth.com
Pronouns: she/her/hers
*Communications are confidential and meant only for whom they are
addressed.*

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