Pregnancy and Heart Disease
At one time, women that had heart disease (elevated blood pressure, heart defects from birth often noted by the presence of heart murmurs, irregular heartbeats, etc.) were advised not to get pregnant. This has changed because most women with heart disease can have successful, healthy pregnancies and healthy babies with some special guidance and planning.
Certainly, pregnant women with co-occurring heart/cardiac disease present special management issues but most of the issues can be overcome with proper medical care, diet, exercise, nutrition, and medication if prescribed by your doctor. Pregnancy is a stressful condition, sometimes emotionally for women and always it is always physically stressful. Your heart is called upon to provide nourishment for two so it needs to work significantly harder supplying blood to both you and your baby.
During pregnancy the mother’s circulatory system, which includes the heart and blood vessels (arteries and veins) undergoes significant changes that may adversely affect both the mother and the fetus. These changes occur throughout pregnancy. Heart disease in pregnant women does occur in approximately 1% of pregnancies and can be a significant cause of health risk for both the mother and the fetus if not properly evaluated and treated.
If you know that you have heart disease, high blood pressure, a heart valve problem or congenital heart abnormality, a heart specialist (cardiologist) should be consulted ideally before you get pregnant. This consultation can prevent problems from occurring during your pregnancy and allow you to be in the best health for you and for your baby.
During the first trimester of the pregnancy, the output from the heart increases significantly due to an increased volume of blood and an elevation heart rate (pulse). These changes are normal, as is a reduction in the mother’s blood pressure. During the third trimester of the pregnancy, the output from the heart may also be altered because of the weight and mass of the fetus in the mother’s uterus. During pregnancy, you may experience a change in the rhythm of your heartbeat. It may skip beats, speed up, and then slow down, etc. These changes occur in most pregnant women and are considered to be normal but if you are at all worried, contact your doctor or nurse.
During pregnancy, it is imperative that a thorough heart/cardiac history be compiled and a baseline electrocardiogram study be conducted early in the mother’s pregnancy. This will help to determine if electrocardiogram studies conducted later in the pregnancy show any significant or worrisome changes.
During pregnancy, some women do develop heart issues even when they were not present before the pregnancy. For example, during pregnancy a significant number of women develop high blood pressure (hypertension), even when their blood pressure was normal before getting pregnant. This condition is defined by a systolic blood pressure (top number) higher than 140 and a diastolic blood pressure (lower number) higher than 90, or both. When this occurs, a pregnant woman may also notice that fluid is being retained especially in her feet and legs and she might feel bloated or swollen. If this occurs, it is important to see your doctor quickly and regularly because these signs could signal a problem that could be harmful to you or your baby.
Some symptoms that occur during pregnancy may be similar to symptoms associated with heart disease but actually be quite normal. For example, fainting may occur and be caused by changes in blood pressure. Fatigue seems to be a universal symptom occurring for all women at times during pregnancy. Chest pain may actually be indigestion often occurring during pregnancy and shortness of breath can occur due to the increased load (weight) that occurs during pregnancy or because of the space that the growing fetus takes up. This exerts pressure on the diaphragm (part of the breathing mechanism). Other problems that can occur during a pregnancy include aggravation of underlying heart defects in the valves, blood vessels that supply nutrients to the heart muscle, and problems with atherosclerosis (clogged arteries). Pregnancy can place a strain on these underlying conditions therefore, early recognition of them is critical.
At each visit to your doctor during your pregnancy, he or she will examine you, listen to your lungs, listen to your heart, check your blood pressure and pulse, and check your ankles for any swelling and weigh you. Many women dislike being weighed at every visit but it is important and one of the ways in which health care providers determine if you are holding fluid that could indicate a problem and place additional strain on your heart. All of these checks help to determine if any changes have occurred since your last visit and to determine if any problems are developing.
Although technically not heart disease, pregnant women may be more likely to develop blood clots in their legs because of normal hormonal changes during pregnancy. If one of your legs is more swollen than the other, if you experience pain behind your knee, redness, or an area of your leg that feels warm to the touch, you should report this immediately to your doctor. Blood clots are much more likely to occur in women that are on bed rest for other reasons, pregnant women taking a long airline flight or a long car ride, women that are overweight, or women that have a family history of blood clots. It is also very important that you not rub or massage the area that you are experiencing pain or warmth in because this could aggravate your condition. Reporting this immediately can allow the doctor to evaluate you and your symptoms and possibly prevent the blood clot from dislodging and causing injury to you or your baby.
Many heart medications are perfectly safe to use during pregnancy and will not cause harm to you or your baby. In fact, if you have a heart problem during pregnancy, more harm can be caused by not treating it properly than by taking medication.
