Heart Conditions During Pregnancy
How Pregnancy Changes the Heart
Pregnancy puts extra demands on the heart and blood vessels. The amount of blood in the body goes up by about one-third to one-half. The heart works harder to move this extra blood, which means the heart rate often increases.
During labor and birth, these demands grow even more. Blood moves quickly and blood pressure can change, especially while pushing. After delivery, the heart’s workload takes weeks to ease.
What Health Dangers Might Happen?
The types and seriousness of risks depend on the person and their specific heart condition. Some people may have only minor problems, while others could face serious threats to health. Some main risks include:
- Abnormal Heart Rhythms (Arrhythmias): These can cause the heart to beat too fast, too slow, or irregularly, raising the risk for blood clots and stroke.
- Issues with Heart Valves: Damaged or missing heart valves may make it difficult for the heart to keep up with the increased blood flow. Mechanical valves also increase the chance of blood clots and infections.
- Heart Failure: If the heart is weak or doesn’t pump as it should, growing blood volume during pregnancy can make heart failure worse.
- Congenital Heart Defects: If someone was born with a heart problem, it can increase the risk of health issues for both mother and baby.
- High Blood Pressure and Preeclampsia: Pregnancy can trigger or worsen high blood pressure and lead to serious problems, like preeclampsia, which affects other organs.
Do Certain Heart Problems Bring Bigger Risks Than Others?
Some heart diseases carry very high threats for pregnant people or their babies. In some cases, doctors may recommend treatments or even warn against pregnancy. Doctors may advise against pregnancy for people with:
- Severe heart failure (class III or IV)
- Weak heart muscle that developed late in a prior pregnancy (peripartum cardiomyopathy)
- Major narrowing of the mitral or aortic valves
- An aortic valve with birth defects and an enlarged aorta
- A strong narrowing in the main artery (coarctation of the aorta)
- Complex birth defects like Eisenmenger syndrome
- Marfan syndrome with a large aorta
- High blood pressure in the lungs (pulmonary hypertension)
In these high-risk cases, the care team may suggest early treatment or, in rare situations, ending a pregnancy to protect the mother’s life.
What Should Be Known About Medications?
Medicines can affect a developing baby, but many are needed to control heart disease. Often, the benefits of taking medicine outweigh possible risks. Healthcare teams choose medicines that are safer for pregnancy and decide on the best dose for each person.
Always follow medication plans and check with your doctor before making any changes. Some heart medicines are not safe to use while pregnant or breastfeeding. Doctors may switch or adjust medicines before or during pregnancy.
Getting Ready for Pregnancy
Anyone with a heart condition should have a health check before getting pregnant. This includes visits with a cardiologist and an obstetrician who has experience with high-risk pregnancies. The care team may:
- Review medicines and stop or change any that are risky for pregnancy.
- See how stable the heart condition is.
- Talk about possible risks to the parent and baby.
- Make plans for extra monitoring during pregnancy.
If a pregnancy happens without planning, see a heart specialist and a high-risk pregnancy doctor as soon as possible.
What Happens During Prenatal Checkups?
People with heart issues need extra care during pregnancy. Prenatal appointments will likely happen more often. Healthcare teams check weight, blood pressure, and signs of heart problems at every visit. Tests that may be done include:
| Test | What it does |
|---|---|
| Echocardiogram | Uses sound waves to show pictures of the heart and its function. |
| Electrocardiogram | Measures the heart’s electrical activity and can spot abnormal rhythms. |
Frequent blood and urine tests may help spot issues early.
How Can Someone Help Keep Their Baby Healthy?
Doctors watch the baby closely with regular ultrasound scans to measure growth and health. If a parent has a heart problem, special ultrasounds check for heart defects in the baby. After birth, a baby might need extra care, especially if there were pregnancy complications or if the baby was born early.
How to Lower the Chances of Problems
Taking care of heart health during pregnancy is key to having the best outcome. Ways to help prevent complications include:
- Go to all prenatal visits. Frequent checkups spot problems early.
- Take prescribed medications. This helps control the heart condition and lowers risk to parent and baby.
- Get plenty of rest. Naps and less physical work can help the heart.
- Watch weight gain. Gaining too much weight can strain the heart.
- Avoid stress and manage anxiety. Learn about pregnancy and delivery, and try calming activities like meditation or gentle walks.
- Avoid substances that can cause harm. Do not smoke, drink alcohol, or use recreational drugs.
- Check with doctors about caffeine. Most people are told to limit caffeine to less than 200 mg a day.
What Signs Should Be Shared Right Away With the Health Care Team?
Tell the medical team about any new or worsening symptoms. Some symptoms may suggest that the heart is under too much pressure or not working right.
Symptoms to Report
- Chest pain
- Shortness of breath that gets worse or happens at rest
- Rapid heart rate or palpitations
- Dizziness or fainting
- Swelling in hands, feet, or ankles
- Big weight gain over a few days
- Severe headaches or seeing spots
- Sudden cough or coughing up blood
What to Know About Giving Birth
Labor and birth put extra stress on the heart and blood vessels. Blood flow and blood pressure can change quickly, and pain and pushing raise the heart’s demands. Most people with heart problems have a birth plan in place that may include:
- Special monitoring during labor for both parent and baby.
- Avoiding medicines or procedures that increase heart strain.
- Sometimes, assisted vaginal delivery with tools like forceps or vacuum to avoid long pushing.
- In rare cases, cesarean birth may be chosen if it’s safer for the heart.
Both the cardiologist and the high-risk pregnancy doctor guide the labor and delivery plans. Sometimes, extra monitoring is needed for several days after birth since the heart still works hard during this time.
Will It Be Possible to Breastfeed the Baby?
Most people with heart problems can breastfeed if they choose. Breastfeeding is usually safe and healthy for both the parent and baby. Some medicines can pass into breast milk. The health care team will talk about which medicines are safe for breastfeeding and if any need to be changed.
If breastfeeding is not safe because of a certain medicine or health risk, the care team helps find other feeding options. If a parent has heart failure or is recovering from a serious event, breastfeeding can take extra energy. The care team can help with tips to make feeding easier and safer.
Breastfeeding Checklist for Heart Conditions
- Check that medicines are safe for nursing.
- Rest when possible.
- Eat healthy foods to support recovery.
- Drink enough fluids.
Staying in touch with the care team helps ensure a safe recovery and a healthy baby.
