'During pregnancy, the position of the heart changes due to the growing baby, and that affects the ECG,' Boonstra explains. 'We know that there are changes in, for example, the activity of the heart, but we don't really know what is 'normal' yet. This makes it difficult to distinguish between normal changes and early signs of heart disease during pregnancy.'   

This lack of knowledge can complicate diagnosis. Boonstra emphasizes, ‘Information in the guidelines is insufficient. If you see abnormalities, you can't always tell if a pregnant woman should be referred immediately or if it's just part of a normal pregnancy.' 

Data from 500 women  

Boonstra's research focuses on establishing a baseline reference for normal changes in the ECG during the various stages of pregnancy. She is doing this by collecting data in 500 women, spanning the three trimesters of pregnancy and the period after.   

'We obtain measurements in women who are already coming to the obstetric practice for standard pregnancy follow-up,' she explains. 'The idea is that four times during pregnancy – in the first, second and third trimester, and postpartum - we include an extra ECG in addition to the usual pregnancy checkups. That way we can get insight in what happens during a normal pregnancy.'   

In addition, data will be collected from women with pre-existing heart disease. 'By comparing these two groups, we hope to make a clear distinction between normal and pathological changes,' says Boonstra. 

The research not only has implications for pregnancy care, but may also be applied more broadly. 'Pregnancy can also be seen as a physiological stress test for the heart,' Boonstra explains. 'It may reveal early signs of heart disease that would otherwise only become apparent later in life. If we can detect those signs during pregnancy, it could provide early detection of heart disease.'   

Moreover, this research could contribute to more personalized care: 'The idea is to model subtle changes based on the ECG data,' she says. 'That way we can use these simulations to determine whether observed changes, for example, is caused by the normal movement of the heart or heart disease.' 

Measurement and data processing  

Much of the work is supported by medical students, they help with the measurements. This makes it not only a research project, but also a learning experience. 'With this research, we can hopefully lay a foundation for better care, not only for women during their pregnancy, but also later in life.' says Boonstra.   

'The money from the AUF Startstipendium will be used to purchase ECG equipment and reimburse medical students who perform the measurements,' Boonstra explains. 'Without this support, it would be difficult to set up a project of this scale.' 
For Boonstra herself, the fellowship also provides an opportunity to further develop her scientific and technical skills. 'This stipendium gives me the space to develop an innovative idea and do something that can have a direct impact on clinical practice. It's incredibly valuable.’ 

A look ahead   

Although the project will start early 2025, Boonstra is already looking ahead. 'The idea is to eventually look at long-term data. If we can follow women over a longer period of time, we may be able to make connections between early signs of disease during pregnancy and later in life. It is very valuable to combine data analysis and technology to better understand this physiological process.’