Pregnancy affects just about every part of your body — including your heart and circulatory system. Starting in the first trimester, your blood volume will increase to nourish your growing baby, so the amount of blood your heart pumps each minute will rise by 30 to 50 percent.
Your heart rate will also go up as your pregnancy progresses, and labor and delivery will put some added stress on your heart too.
All these changes are normal during pregnancy, but for moms-to-be who have preexisting heart conditions (including congenital heart disease, which is a defect or condition you were born with), the strains on the circulatory system can add some risks[1] to your pregnancy.
Happily, with extra care and an expert medical team, many women with heart conditions can have healthy pregnancies.
What should I do if I have heart disease or another heart condition and want to get pregnant?
It’s important to get a thorough preconception checkup with your OB/GYN[2] and your cardiologist. Your doctors may also suggest that you meet with a maternal fetal medicine specialist (an OB/GYN who treats high-risk moms-to-be) for further evaluation.
Most of the time — especially if you’re able to function well with your heart condition — your medical team will give you the go-ahead to conceive.
If you’re somewhat restricted because of your heart disease or other heart condition — or you have an unrepaired heart defect — your physicians might want to do additional testing and treatment before you get pregnant.
In rare cases, you might be advised to avoid pregnancy altogether because it would be too risky.
If you’re taking medications for your heart condition, your doctors will need to evaluate all of them to see which are safe to continue during pregnancy. They may suggest that you try a different treatment that's pregnancy-safe or one that carries lower risks for you and your baby.
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What heart conditions may cause problems during pregnancy?
Some underlying heart conditions in expectant moms cause little to no problems during pregnancy, while others may be much riskier for you and baby and increase your chance of pregnancy complications.
The World Health Organization (WHO) groups maternal heart conditions into four risk categories, with class I conditions carrying the lowest risk of complications and class IV conditions carrying the highest risk. Your doctors may determine your risk class even before you get pregnant.
Simple congenital heart defects that have been successfully repaired (atrial or ventral septal defects and patent ductus arteriosus, for example), mild heart valve deformities, and heart murmurs are usually considered low-risk.
If you have congenital heart disease, you are at a slightly higher risk of having a miscarriage, a premature birth or a low birth weight baby.
More serious heart conditions might include:
- Severe or unrepaired heart valve deformities
- Most arrhythmias (irregular heartbeat)
- Complex congenital heart defects (including Tetralogy of Fallot)
- Cardiomyopathy (weakened heart muscle)
- Some forms of Marfan syndrome
Certain heart conditions would make pregnancy too risky, and your doctor will likely advise you against getting pregnant. These include Marfan syndrome with a severely enlarged aorta, severe aortic stenosis, severe pulmonary hypertension, Eisenmenger syndrome and congestive heart failure.
What special monitoring will I need during pregnancy if I have heart disease or another heart condition?
Besides your regular prenatal visits to check that your pregnancy is healthy and progressing as it should, you and your medical team will need to make sure your heart disease or other heart condition isn’t negatively affecting your pregnancy.
How much additional monitoring you’ll need will depend on the severity of your heart condition. If it falls into the low-risk category, you may only see your cardiologist once or twice during your entire pregnancy. If your condition is more serious, you’ll need to see the cardiologist more frequently, probably about every two to four weeks.
Your practitioner will use a number of tests to make sure your heart is working well. These tests (which you’ve likely had many times before) might include an echocardiogram (echo) and an electrocardiogram (EKG).
Routine ultrasounds will help monitor your baby’s growth and development to make sure it's on track. Specialized ultrasounds (fetal echocardiograms) can help detect any fetal heart problems early on. This is usually performed by a maternal fetal medicine specialist or pediatric cardiologist.
Your doctors will closely monitor your heart through labor and delivery too. They’ll track all your contractions and carefully watch your baby’s heart rate.
You might be asked to lie on your side or sit up instead of laboring flat on your back. If you’re at very high risk, you might even have a catheter placed into a vein or artery to more closely monitor your heart function. If endocarditis (an infection of the heart's inner lining) is a concern, you might receive antibiotic treatment just before and after delivery.
Depending on the severity of the condition, a C-section may be recommended, or an assisted vaginal delivery with forceps or vacuum may be advised in order to avoid pushing at the end of the labor.
After delivery, depending on the severity of your condition, some patients may need more intensive monitoring or require a temporary ICU admission to make sure you are recovering appropriately from the delivery.
Are there symptoms I should watch out for?
Contact your prenatal practitioner if you notice anything out of the ordinary, even if you just feel as though something isn't quite right.
Call your doctor immediately if you have trouble breathing or are short of breath, if you feel heart palpitations or an irregular pulse, or if you have chest pain. If you can't reach your provider, call 911 or go to the emergency room.
If I have a congenital heart defect, is my baby at risk of having one too?
It’s possible that you'll pass the condition on to your baby, but it’s not a sure bet. Some congenital heart defects are more strongly tied to genetics than others. Your baby will be closely monitored to see how his tiny heart is developing.
Ideally, you’ll meet with a genetic counselor before getting pregnant, who can help you determine your risk for having a child with a congenital heart defect.
Depending on your specific heart condition, you likely have a good shot at having a healthy pregnancy and baby with the right medical care and monitoring. Adopting healthy pregnancy habits — like getting plenty of rest, keeping your stress levels down as much as possible, eating well and avoiding smoking and alcohol — can also help minimize the risk of pregnancy complications.
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