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Heart problems and pregnancy: Know the risks
Pregnancy stresses your heart and circulatory system, but many women who have heart problems deliver healthy babies. Know the risks — and how to help prevent complications.
By Mayo Clinic staffMany women who have heart problems deliver healthy babies. Still, any heart condition requires special care during pregnancy. If you have a heart condition and are considering pregnancy, here's what you need to know.
How does pregnancy affect the heart?
Pregnancy stresses your heart and circulatory system. During pregnancy, your blood volume increases by 30 to 50 percent to nourish your growing baby. The amount of blood your heart pumps each minute also increases by 30 to 50 percent. Your heart rate increases as well. These changes cause your heart to work harder.
Of course, labor and delivery add to your heart's workload, too. During labor — particularly when you push — you'll experience abrupt changes in blood flow and pressure. When your baby is born, decreased blood flow through the uterus also stresses your heart.
What are the risks?
The risks depend on the nature and severity of the underlying heart condition. For example:
- Minor abnormalities in heart rhythm — such as occasional extra atrial or ventricular beats — are common during pregnancy. They're not usually cause for concern.
- If you have an artificial heart valve or your heart or valves are scarred or malformed, pregnancy complications may pose a risk of endocarditis — a potentially life-threatening infection of the lining of the heart and heart valves. Mechanical artificial heart valves also pose serious risks during pregnancy due to the need to adjust use of blood thinners and the potential for life-threatening clotting (thrombosis) of heart valves.
- Congestive heart failure may worsen as blood volume increases.
- If you have a congenital heart problem — a malformation that was present when you were born — your baby has a greater risk of developing one, too. You also may be at risk of premature delivery.
Do some heart conditions cause more complications than others do?
Certain heart conditions may pose life-threatening risks for mother or baby, including:
- High blood pressure in the arteries in the lungs and the right side of the heart (pulmonary hypertension)
- Severely obstructed blood flow between the left chambers of the heart (mitral valve stenosis)
- Severe narrowing of the aortic valve, which obstructs blood flow from the heart to the aorta (aortic valve stenosis)
- Marfan syndrome, a condition that weakens connective tissue in the body
- Eisenmenger's syndrome, a rare congenital condition often characterized by a large hole in the heart and high blood pressure in the arteries in the lungs
- Cyanotic heart defects, a group of defects in which blood pumped to the body contains less oxygen than normal
These conditions may require major treatments, such as heart surgery, before you try to conceive. The risk of pregnancy in women who have severe pulmonary hypertension or Eisenmenger's syndrome is so high that pregnancy isn't recommended.
What about medication?
Any medication you take during pregnancy can affect your baby. Often the benefits outweigh the risks, however. If you need medication to control your heart condition, your health care provider will prescribe the safest medication at the most appropriate dose. Take the medication exactly as prescribed. Don't stop taking the medication or adjust the dose on your own.
What should I do to prepare for pregnancy?
Before you try to conceive, schedule an appointment with your cardiologist and the health care provider who'll be handling your pregnancy. Also meet with other members of your health care team, such as your family doctor. Your medical team will evaluate how well you're managing your heart condition and consider any treatment changes you may need to make before pregnancy begins.
Certain medications commonly used to treat heart conditions aren't used during pregnancy. Depending on the circumstances, your health care provider may adjust the dosage or make a substitution and explain the risks involved.
Next page(1 of 2)
- Pregnancy and heart disease. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4688. Accessed April 22, 2009.
- Fetal echocardiography. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=3005386. Accessed April 22, 2009.
- Heart disorders in pregnancy. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec18/ch261/ch261i.html. Accessed April 22, 2009.
- Congenital cardiovascular defects. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4565. Accessed April 22, 2009.
- Risk factors present before pregnancy. The Merck Manuals: Home Edition for Patients and Caregivers. http://www.merck.com/mmhe/sec22/ch258/ch258b.html. Accessed April 22, 2009.
- Siu SC, et al. Heart disease and pregnancy. Heart. 2001;85:710.
- Perloff JK. Pregnancy in women with congenital heart disease: General principles. http://www.uptodate.com/home/index.html. Accessed April 23, 2009.
- DeCara JM. Management of heart failure in pregnancy. http://www.uptodate.com/home/index.html. Accessed April 23, 2009.
- Arafeh JM, et al. Cardiac disease in pregnancy. Critical Care Nursing Quarterly. 2006;29:32.
- Infective endocarditis (previously referred to as bacterial endocarditis). American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4436. Accessed May 12, 2009.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. May 18, 2009.
