Heart Disease and Pregnancy

Maternal heart disease includes heart defects that are present at birth and acquired heart disease later in life. These can range from simple to complex.

Examples include:

• A hole in the wall between the two sides of the heart
• A heart valve that is too narrow or one that doesn’t open or close properly
• A problem with the heart muscle that prevents it from pumping efficiently
• Issues with the arteries and veins that carry blood to the heart or body
• Development of irregular heart rhythms
• Coronary artery disease leading to a heart attack

Pregnancy is Possible

While historically women with heart disease were advised against pregnancy, thanks to decades of advancements in diagnostics and treatment, today pregnancy is possible.

According to new guidance issued by the American Heart Association, recent studies show that even women with complex congenital heart conditions may be able to have successful pregnancies.

The key to ensuring the healthiest possible pregnancy for you and your baby? Working with an experienced team of doctors who specialize in treating pregnant women with congenital heart defects and acquired heart disease.

Pregnancy and Your Heart

Changes in the body during pregnancy place increased stress on your heart and circulatory system. During pregnancy:

• Your blood volume increases by about 40 percent
• Cardiac output – the amount of blood your heart pumps each minute – increases 30 to 50 percent
• Your heart rate rises 10 to 20 beats per minute

Contractions during labor and pushing during delivery also cause abrupt, major changes in blood flow, blood pressure, heart rate and cardiac output.

Your heart’s ability to tolerate these dramatic changes will depend on your defect and how well your heart is working. 

Understanding the Risks

While the risks depend on your unique condition and overall health, pregnancy complications for women with heart disease may include:

• Irregular heartbeat, known as heart arrhythmias
• Heart valve issues caused by increased blood flow
• Increased risk of endocarditis, an infection of the lining of the heart and heart valves
• The risk of blood clots and stroke, as blood thinner use is adjusted during pregnancy
• Congestive heart failure
• A congenital heart defect in your baby
• Higher-than-average risk of miscarriage, premature birth and poor fetal growth

Assembling the Right Team

Your safety and the safety of your baby depend on assembling a team of experts experienced in managing these high-risk pregnancies. The American Heart Association recommends that women with complex heart defects give birth in medical centers that have access to the broad range of expertise required by these high-risk pregnancies.

Your team should include:

• An OB/GYN with specialized training and experience in treating high-risk pregnancies, known as a maternal-fetal medicine specialist
• A cardiologist who specializes in treating Adult Congenital Heart Disease and acquired heart disease
• Your obstetrician
• Your primary care doctor
• An anesthesiologist with expertise in treating women with maternal heart disease
• A geneticist/genetic counselor
• A heart surgeon, if needed
• Fetal intervention specialists and pediatric surgeons, if needed

Treatment Before, During and After Pregnancy

Your medical team should work together from preconception to post-delivery to:

• Assess your personal risks of pregnancy and delivery
• Determine surgical or interventional treatments necessary for your heart during or after pregnancy
• Determine medical therapy needed during pregnancy, either new medications or those that need to be stopped for safety reasons
• Assess the risk of your child inheriting a heart defect
• Assess the need for a fetal echocardiogram to evaluate your baby’s heart
• Develop a carefully planned delivery specific to your condition
• Monitor you closely for months following delivery, for any lingering effects of pregnancy on your heart