Pregnancy can take on a whole new set of concerns for women with heart problems. Here, Drs. Katharine Wenstrom, MD, and Kenneth Chen, MD, of the Integrated Program for High-Risk Pregnancy at Women & Infants Hospital, offer some insight into heart health in pregnancy.
How does pregnancy affect the heart?
The heart works harder during pregnancy. By the middle of pregnancy, a woman’s blood volume and the amount of blood pumped by the heart increases by 50 percent. During labor, the blood pumped increases by 30 percent more.
Healthy women tolerate the increased work of the heart very well. It is very common that women with no previous history of cardiac disease have symptoms for the first time in pregnancy. For a pregnant woman with heart disease, the main risk is that her heart will not tolerate the strain of pregnancy and will fail. Some women with chronic cardiac disease need specialty care to avoid heart failure or damage. Yet, rarely is a woman’s underlying heart disease so severe that she is advised to avoid pregnancy.
How do I prepare for pregnancy?
Women with any chronic medical condition may benefit from preconception counseling to get specific advice. In general, women should:
- Get into the best physical shape possible before attempting to get pregnant. Work with your doctor to develop an exercise plan that is safe for you. Getting to or maintaining a healthy weight to avoid certain pregnancy complications, such as high blood pressure or diabetes, may help avoid a cesarean section or other delivery complications.
- Go over your medications with your doctor to find out which ones are safe to continue and which ones should be stopped before you conceive.
- Stop smoking, and don’t use alcohol or recreational drugs.
- Take a multivitamin with folic acid, which prevents several birth defects that develop in the early weeks of pregnancy.
Do some heart conditions cause more complications?
Yes, some cardiac conditions increase the risk of complications. Any woman with physical limitations because of cardiac disease before becoming pregnant may not tolerate pregnancy well. Specific problems likely to cause problems during pregnancy include: pulmonary hypertension, Marfan syndrome, pre-existing coronary artery disease, cardiomyopathy, or the presence of a prosthetic heart valve.
If I am pregnant, how can I make sure my baby is okay?
Your provider will check the baby’s heart rate at each visit. At 20 to 22 weeks, you will feel the baby moving. Feeling fetal movement on and off throughout the day is the best way to know the baby is healthy. If you notice a decrease in movement, tell your provider. You will also have ultrasound exams to check the baby’s anatomy and growth. If you have a cardiac condition that could affect fetal growth, or if you have high blood pressure or another medical problem, your provider will start weekly fetal monitoring around 32 weeks to be sure the baby is healthy. Report any change in your symptoms or the baby’s activity to your provider. For cardiac patients, these could include:
- Excessive tiredness.
- Palpitations or chest pain.
- Inability to sleep lying flat because of breathing problems.
- Pain or swelling in the legs.
- Decrease in movement by the baby.
What about labor and delivery?
In most cases, a board-certified obstetrician/gynecologist can take care of a woman with underlying cardiac disease during labor and delivery. Depending on your specific cardiac problem, your provider may need help from anesthesiologists, maternal-fetal medicine specialists, neonatologists, or internal medicine specialists, such as cardiologists or nephrologists. Depending on your history and how your pregnancy goes, your provider may plan to have you deliver in a tertiary care hospital like Women & Infants, where these specialists are routinely available.