Maternal Health: Heart Conditions During Pregnancy
by Jake Newby
| 5 min read
Living with a heart condition doesn’t mean you can’t become pregnant, deliver a healthy baby, and live a long, healthy life without complications. But all women should be aware of the health risks associated with having a heart condition during pregnancy.
In the United States, cardiovascular disease is the leading cause of death in pregnant women and women in the postpartum period. Heart and blood vessel conditions – like coronary heart disease, high blood pressure, stroke, and cardiomyopathy – can be dangerous for the expecting mother. But they are preventable if proper precautions are taken before, during, and after pregnancy.
Risk Factors for pregnancy-related heart issues
Pregnancy-related heart problems can happen to any woman, but disparities in cardiovascular disease outcomes include higher rates of morbidity and mortality among nonwhite and lower-income women.
According to the American College of Obstetricians and Gynecologists, contributing factors include:
- Barriers to pre-pregnancy cardiovascular disease assessment
- Missed opportunities to identify cardiovascular disease risk factors during prenatal care.
- Gaps in high-risk intrapartum care
- Delays in recognition of cardiovascular disease symptoms during the puerperium
The National Heart, Lung and Blood Institute states that pregnancy-related heart problems can also occur in women who:
- Are 40 or older
- Are African American, American Indian, or Alaska Native
- Are overweight or have obesity
- Drink alcohol
- Get little physical activity
- Have an existing health condition, such as diabetes, high blood pressure, blood clotting disorders, sleep apnea, anemia, or polycystic ovary syndrome (PCOS)
- Have existing heart disease, such as congenital heart disease or heart valve disease
- Have heart problems
- Smoke cigarettes
- Use opioids or other illegal drugs
Heart problems that affect pregnant women can be broken down into two categories: preexisting heart conditions and heart conditions that develop during pregnancy. The most common types of preexisting heart conditions can range in severity and are detailed below.
Preexisting heart conditions during pregnancy
- Cardiomyopathy: Cardiomyopathy, which means heart muscle disease, is the leading cause of serious complications and death during pregnancy. Peripartum cardiomyopathy is the leading cause of death in expectant mothers, accounting for 23% of deaths late in pregnancy, according to the American College of Obstetricians and Gynecologists. Hypertrophic cardiomyopathy is less dangerous during pregnancy. Two of its most frequent symptoms are shortness of breath (dyspnea) and chest pain.
- Congenital heart disease: This is the most common form of cardiovascular disease among pregnancies in the United States. Ranging from mild to very serious, these are conditions people are typically born with. Women with congenital heart disease face a higher risk of premature birth. Common complications among pregnant women with congenital heart disease include abnormal heartbeat (arrhythmia) and heart failure.
- Heart valve disease: There are many types of heart valve diseases, not all of which affect pregnancy. Having an artificial heart valve can increase your risk of complications during pregnancy. Valve replacement helps many people with valve disease to live long, healthy lives, but people with a prosthetic (artificial) heart valve need special care during pregnancy, because pregnancy increases the risk for blood clots. People with certain artificial valves need to take lifelong medications to lower their risk of blood clots, which can be harmful to the fetus. If you do have an artificial valve, visit with a cardiologist as you plan your pregnancy to discuss risks and precautions.
Heart conditions that can develop during pregnancy
Minor abnormalities in heart rhythm are common during pregnancy and are usually not serious. If you need treatment for an arrhythmia, your primary care provider (PCP) will likely prescribe medication.
Changes to the heart and blood vessels are also common during pregnancy. During pregnancy, blood volume typically increases from 30% to 50% during pregnancy to provide adequate nourishment to a growing baby. It’s also normal for heart rate to increase by 10 to 20 beats per minute during pregnancy, rising gradually before plateauing during the third trimester.
Labor and delivery can also lead to a drastic increase in a woman’s heart rate and blood pressure.
While it may be common to experience the following symptoms as a result of these changes (during pregnancy):
- Dizziness or lightheadedness
- Palpitations (sensation of a fast heartbeat)
These symptoms can overlap with symptoms of heart disease. It is important to be sure to note when they occur and speak with your Obstetrician-who might refer you to your PCP if you experience any of them.
High blood pressure during pregnancy
High blood pressure can be diagnosed for the first time during pregnancy. It is routinely screened for, especially in women with any risk factors. Complications for the mother and infant can include the following:
For the mother:
- Placental abruption (the placenta separating from the wall of the uterus)
- Preeclampsia (kidney damage)
- The need for labor induction
For the baby:
- Low birth weight (when a baby is born weighing less than 5 pounds, 8 ounces)
- Preterm delivery (birth that happens before 37 weeks of pregnancy)
It is so important that expecting mothers receive early and regular prenatal care if they struggle with high blood pressure. Your obstetrician will discuss safe medications, dietary recommendations, suggest more frequent visits, and may even suggest that you monitor your blood pressure at home.
If you’re not yet pregnant, develop heart-healthy habits now to set yourself up for a healthy pregnancy. These can include eating healthy foods, getting regular exercise, aiming for a healthy weight, managing stress, getting enough good quality sleep, and quitting smoking if you are a smoker.
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