Heart Disease in Pregnancy

During pregnancy, women’s hearts and blood vessels are put under increased pressure. This can cause symptoms of an underlying heart condition to occur for the first time or cause an existing heart condition to worsen.

Our Heart Disease in Pregnancy Program provides specialized care for those women who may be at high-risk for heart disease and for those with a pre-existing cardiovascular condition, such as coronary artery disease. Our team provides care for women with a heart condition who are planning to become pregnant, have a heart condition and are pregnant, and those women who begin experiencing heart disease symptoms when pregnant.

Our multidisciplinary team provides the full scope of services, including:

• Preconception counseling and risk stratification
• Pregnancy care, including development of an individualized labor plans
• Access to fetal echocardiography throughout your pregnancy
• Coordinated postpartum care including counseling

Our team sees women with all forms of pre-existing cardiovascular conditions, including arrhythmias, congenital heart disease, coronary artery disease, high blood pressure or hypertension, heart valve disease and peripartum cardiomyopathy. Whether you have a preexisting cardiac condition or develop one during your pregnancy, you can be confident in choosing our team of specially trained experts.

Counseling Before You Conceive

If you have a pre-existing heart condition, you will want to talk to your heart specialist before you conceive. Depending on your condition and medications, you may encounter fertility issues, medication concerns, pregnancy risks and delivery concerns.

Some types of congenital heart disease may be associated with fertility concerns. Talking with your primary cardiologist, obstetrician, primary care doctor and possibly a reproductive medicine specialist can help address these concerns. Our Reproductive Medicine Center doctors specialize in fertility challenges and can provide a wide variety of options to address conception issues.

Your cardiologist can go over your medications to determine if they could affect your fertility and if they are safe to take while you are pregnant. We'll also make sure that prenatal medications won't have a negative interaction with your heart medications.

A heart-healthy lifestyle — exercise and a healthy diet — is always important. Talk with your provider about whether you have activity restrictions before starting an exercise program.

Your type of heart disease will determine which risks could arise during your pregnancy. The most common risks include:

• Arrhythmias
• Preterm labor
• Hypertensive disorders of pregnancy
• Symptoms of heart failure

You can mitigate these risks with preconception counseling and following up as directed by your cardiologist and obstetrician.

What to Expect

During your first visit with our team, we will complete an in-depth medical history review, including discussing current cardiac concerns or risk factors for cardiac disease you may have. At your initial visit, our team may order diagnostic testing, including blood tests, exercise stress tests, echocardiograms or electrocardiograms, to analyze your heart health.

During your exam, our team will analyze your diagnostic test results and your medical history, including preexisting conditions or risk factors for cardiac disease, to develop an individualized care plan.

Care plans vary based on each woman’s unique situation. If you are at high-risk for cardiovascular disease or have a preexisting condition for example, your care may involve a high-risk obstetrician or congenital heart disease cardiologist. Additional treatment options may include medical management, a customized labor plan, regular diagnostic testing to monitor for changes in heart health and fetal echocardiography.

Symptoms of a New Heart Condition During Pregnancy

Your body goes through a lot of changes when you are pregnant. Some changes are a normal part of pregnancy. Others may be cause for concern. If a symptom is limiting your ability to do normal daily activities or you are concerned about a particular symptom, you should discuss it with your doctor.

Symptoms that are cause for concern may include:

• Excessive shortness of breath (more than expected for a specific stage of pregnancy)
• Chest discomfort (primarily with activity)
• Significant swelling (more than expected for a specific stage of pregnancy)
• Heart palpitations
• Passing out or significant lightheadedness

What Causes Heart Disease in Pregnancy

Most heart conditions already exist before you become pregnant. Many women who develop heart conditions during pregnancy were born with heart disease (congenital heart disease). Congenital heart disease is the most common type of heart disease seen in women of childbearing age in the U.S. Many of these women have had surgery as a child to either repair or reduce the congenital heart defect.

If you had surgery related to a heart condition, we recommended that you see a cardiologist and maternal fetal medicine doctor prior to attempting a pregnancy in order to evaluate potential pregnancy risks.

Some women have a cardiovascular disease that developed in adulthood, such as coronary disease or hypertension. These women should also be seen prior to a pregnancy by a cardiologist and MFM to evaluate the risks of a pregnancy. 

You may not be aware that you have a heart condition until the stress of pregnancy causes symptoms to develop. Again, you will want to talk to your doctor if you develop any of the symptoms listed above. Our doctors have extensive experience with lessening your pregnancy risks and treating heart disease symptoms.

Most Common Heart Diseases in Pregnancy

Congenital heart disease is the most common heart condition that can affect pregnancy. Other conditions include:

• Arrhythmias
• Congenital heart disease
• Coronary artery disease
• High blood pressure or hypertension
• Heart valve disease
• Peripartum cardiomyopathy

The severity of these conditions varies. If you have a heart condition, you can still have a healthy pregnancy. It is important to talk through all of your medications, lifestyle, limitations, symptoms and risks before you get pregnant. Our specialists can advise on whether it is safe for you to get pregnant and provide strategies to manage both your heart condition and your pregnancy.

How You Can Prevent Pregnancy Complications

The best way to prevent complications is to have preconception counseling to evaluate your pregnancy risks. If you know you have heart disease, follow up with your doctors during your pregnancy. If you have no history of heart disease, follow a heart-healthy lifestyle (heart-healthy diet and exercise) and discuss any concerns or symptoms with your doctors.

Fetal Monitoring

We recommend fetal echocardiography if you have congenital heart disease. Otherwise, we would prescribe fetal echocardiography if there was a question or concern from the fetal ultrasound. Continue to follow up with your provider and get the recommended testing to identify or monitor a heart condition during a pregnancy.

Labor Plans

Labor plans are very specific to the type of heart disease the mother has and how severe it is. With few exceptions, women with heart disease during a pregnancy can have a vaginal delivery. Sometimes, we recommend you have an epidural to prevent high blood pressure and high heart rates during labor. We may recommend you wear a heart rhythm monitor during labor and delivery, and some women may need medication, such as antibiotics.

You will want to discuss your specific labor plan during a visit with your obstetrician and note any concerns you have regarding your heart condition. Ask your doctor if you will need to remain in bed during labor or if you can walk around, soak in a tub or sit on a ball.

Postpartum Care

Postpartum care depends on the severity and type of heart disease and if there were any complications during labor. It is rare that you would require a longer stay, though you may need to remain on a heart-rhythm monitor for 24 to 48 hours after delivery. You may need specific heart-related medications in the postpartum period. Talk to your cardiologist and obstetrician about any special follow-up appointments or monitoring after you go home.

Having Another Baby

Whether you can have another baby will depends on your heart disease and its severity at the time of the next pregnancy. You will want to repeat the preconception counseling steps again to evaluate the risks prior to each subsequent pregnancy.

Evolving Care Through Research

As part of an academic medical center, we are continuously involved in leading-edge research to develop new methods for identifying patients at increased risk of developing cardiac events during pregnancy and researching strategies to reduce to risk of cardiac events for pregnant women. Learn more about cardiovascular research.

Collaborative Team Approach

Our Heart Disease in Pregnancy Program brings together board-certified experts in adult congenital heart disease, cardiology, maternal fetal medicine, obstetrics and anesthesiology. These experts collaborate with a team of specialty trained nurses and medical staff.

Together, this team develops care plans for each patient, based on the opinion of multiple experts across disciplines.

When needed, we can also collaborate with experts across the health network, including those in interventional cardiology, advanced heart failure, electrophysiology, cardiac surgery, pediatric cardiology, genetics and neonatology to deliver advanced care based on the patient’s needs.