Heart Disease and Pregnancy

Women who are pregnant experience changes to the heart and blood vessels, which puts extra stress on the body because the heart has to work harder. For women with heart disease, special precautions must be taken during pregnancy. If you have a heart condition, you should be evaluated by a cardiologist and an obstetrician, who specializes in high-risk pregnancy, before you start planning a pregnancy.

Heart Changes During Pregnancy

Because your body’s working hard to make sure your growing baby gets enough oxygen and nutrients, the following changes are common during pregnancy:

• Increase in blood volume. The amount of blood in the body increases by 40-50% during the first trimester of pregnancy.
• Increase in cardiac output. Because of the increase in blood volume, the amount of blood pumped through the heart each minute increases by 30-40%.
• Increase in heart rate. The heart rate increases by 10-15 beats per minute during pregnancy.
• Decrease in blood pressure. Blood pressure can decrease by 10 mmHg during pregnancy due to hormone changes and more blood being directed towards the uterus. This blood pressure drop typically doesn’t come with symptoms and no treatment is needed. Your healthcare provider will check your blood pressure during prenatal appointments and will tell you if blood pressure changes are a cause of concern.

All of the changes described above can cause symptoms that include fatigue, shortness of breath, and light-headedness. These symptoms are normal, but if you’re concerned or have any questions, talk with your healthcare provider. If you have a heart condition, you may need to take special precautions before and during pregnancy.

Cardiovascular Disorders That Can Develop During Pregnancy

• Peripartum cardiomyopathy. This is a rare condition that involves heart failure during the last month of pregnancy or within five months after delivery. While the cause of peripartum cardiomyopathy is unknown, it’s known to affect women with multiple pregnancies and those of African descent. After pregnancy, the heart usually returns to its normal size and function, but some women continue to have symptoms. Women with peripartum cardiomyopathy are at risk for complications during future pregnancies.
• Hypertension. Roughly 6-8% of women develop high blood pressure, also called hypertension, during pregnancy. Known as pregnancy-induced hypertension, this condition is related to preeclampsia, toxemia or toxemia of pregnancy. Symptoms include high blood pressure, swelling due to fluid retention and protein in the urine. Pregnancy-induced hypertension can be harmful to the mother and baby, so talk with your doctor if you think you’re at risk.
• Myocardial infarction. While extremely rare, a heart attack (myocardial infarction) can occur during pregnancy or during the first few weeks after delivery. Patients with coronary disease (hardening of the arteries) can have a heart attack if the plaque inside their arteries ruptures. Other causes include a spontaneous blood clot inside a coronary vessel and coronary dissection, a weakening of the vessel that leads to a tear or clotting.
• Heart murmur. Due to the increase in blood volume during pregnancy, some women experience heart murmur. In most cases, this is harmless, but in rare cases, it can mean there are problems with a heart valve.
• Arrhythmias. It’s common for women to experience irregular heartbeats (arrhythmias) during pregnancy. These irregular heartbeats typically don’t come with symptoms and don’t require treatment. If you develop an arrhythmia during pregnancy, it can also be a sign of a heart condition you didn’t know about.

Planning Pregnancy with Heart Disease

The American Heart Association recommends scheduling a pre-pregnancy evaluation with your primary doctor and cardiologist to discuss any concerns you may have regarding pregnancy and heart disease.

Women with repaired congenital heart disease can have a safe pregnancy with very little risk. It’s important to note that body changes during the second and third trimester can cause an increase in symptoms, even in women without preexisting problems.

If you have heart disease, make sure you talk with your doctor before getting pregnant and make sure to take care of the following:

• Talk to your doctor about your form of heart disease. Some forms of heart disease are such a high risk to the mother and baby that pregnancy isn’t recommended. These conditions include severe heart failure, pulmonary hypertension, cyanosis, and Eisenmenger syndrome.
• Take care of your blood pressure. If you have high blood pressure before pregnancy, talk with your doctor and devise a plan for lowering it through diet and exercise.
• Talk with your doctor about your blood pressure medication. Certain medications, like ACE inhibitors or ARBs have been shown to be dangerous for mothers and babies during pregnancy because they can cause kidney failure, high potassium levels and low blood pressure.

For women with heart disease, it’s important to schedule regular checkups with your doctor throughout your pregnancy.

Pregnancy with Heart Disease

Women who are pregnant and have heart disease can have a healthy pregnancy. By making sure to follow a heart-healthy diet, exercising, maintaining primary doctor and cardiologist appointments, and knowing all of your options for labor and delivery, you can increase your chances of having a healthy pregnancy.

Your cardiologist can monitor your heart condition throughout the pregnancy and treat any complications that may occur.

There are some heart conditions that require a team approach throughout your pregnancy, labor and delivery. Depending on which condition you have, you may have to involve your obstetrician, cardiologist, anesthesiologist, and pediatrician.

Learn More About Heart Disease and Pregnancy

If you have additional questions about heart disease and pregnancy, contact the Baptist Health Women’s Services team to schedule an appointment.