Tommi Black is ready to be a mother of twins, but it has not been a problem-free pregnancy.
"Shortness of breath -- that's my main concern, is shortness of breath," she said.
Dr. Andra James ordered her to stay off her feet in bed until a scheduled Cesarean section on May 1. She actually had a heart attack two years ago at age 20.
"Due to stress and smoking, a little bit of everything I guess," Black said.
Black's nine-year smoking habit continued through the first weeks of pregnancy.
"She saw my hair stand on end and she listened to a lot of sermons," James said.
"That was probably the hardest thing I've had to do since pregnancy, was to cut my smoking," Black said.
Black finally quit, but the years of smoking on top of a family history of heart disease make it a risky pregnancy.
James leads a Duke study that shows pregnancy is, in itself, a risk factor, even though it is a small one.
"The risk is not zero. And when women do have chest pain in pregnancy, this is a possibility," James said.
Especially when pregnancy is paired with other risk factors like high blood pressure, high cholesterol, being overweight and smoking.
"We're pretty good about counseling her about the risks to her baby of smoking, but we haven't really paid much attention to the actual risks to her," James said.
Black and her parents hope she has done enough to assure not only that her twins will be born healthy, but that she will be a healthy mom.
"I'm really looking forward to them," Black said.
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