Heart Disease in Pregnancy

Some pregnant women with heart disease can face serious complications while they are expecting. Between 5%-15% of these pregnant women are at risk for:

• Arrhythmias, which are improper beatings of the heart
• Congestive heart failure, a condition where the heart does not pump blood the way it should
• Pulmonary embolism, which occurs when there is a blockage in one of the pulmonary arteries in the lungs
• Cardiac death.

These conditions all have the potential for lifelong, adverse health effects in both mother and child.

Risk factors for cardiac complications include:

• Advanced maternal age, defined as being 35 years or older
• Hypertension (also called preeclampsia)
• Diabetes mellitus or diabetes, which is a disease that causes high blood sugar
• Smoking
• Pre-existing heart conditions, such as congenital heart disease

Research has shown that approximately 50% of serious cardiac complications in pregnant women are preventable. Unfortunately, these cardiac complications tend to be undiagnosed.

What are the signs?

Symptoms of chest pain, extreme weight gain or swelling, extreme fatigue, shortness of breath when lying down, fast heartbeat and fainting may be a sign of developing heart complications during pregnancy.

How to prevent heart disease in pregnancy

There are several steps expecting mothers can take to prevent heart disease:

• Women with known heart disease should have preconception counseling with a multidisciplinary team (cardio-obstetrics) to discuss the risk of pregnancy.
• Review all medications with your doctor before conception and during pregnancy.
• Monitor your blood pressure
• Start health habits, such as following a healthy, low-salt diet, moderate exercise and weight loss
• Stop all tobacco use and alcohol use before pregnancy.
• Keep all prenatal appointments and postnatal follow-up visits.

Sources

• Elkayam U, Goland S, Pieper PG, Silverside CK. High-Risk Cardiac Disease in Pregnancy: Part I. J Am Coll Cardiol. 2016;68(4):396-410. doi:10.1016/j.jacc.2016.05.048
• Elkayam U, Goland S, Pieper PG, Silversides CK. High-Risk Cardiac Disease in Pregnancy: Part II. J Am Coll Cardiol. 2016;68(5):502-516. doi:10.1016/j.jacc.2016.05.050
• Lau E, DeFaria Yeh D. Management of high risk cardiac conditions in pregnancy: Anticoagulation, severe stenotic valvular disease and cardiomyopathy. Trends Cardiovasc Med. 2019;29(3):155-161. doi:10.1016/j.tcm.2018.07.00
• Pfaller B, Sathananthan G, Grewal J, et al. Preventing Complications in Pregnant Women With Cardiac Disease. J Am Coll Cardiol. 2020;75(12):1443-1452. doi:10.1016/j.jacc.2020.01.039
• Mehta LS, Warnes CA, Bradley E, et al. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association [published correction appears in Circulation. 2020 Jun 9;141(23):e904]. Circulation. 2020;141(23):e884-e903. doi:10.1161/CIR.0000000000000772