Heart

Managing Heart Disease During Pregnancy

With a little planning and the right information, most women with heart conditions can have a safe and healthy pregnancy.

Heart

There’s a misconception that women living with a heart condition should never get pregnant, but in fact heart disease can be safely managed during pregnancy, says Stephanie Martin, D.O., medical director for labor and delivery and the obstetric intensive care unit at the Texas Children’s Pavilion for Women in Houston. “An evaluation is important to determine whether pregnancy is a good idea, but it’s very rare that a patient’s heart condition would make pregnancy too risky.” In some cases, “the hormonal changes in pregnancy actually help a compromised heart work better,” adds John Folk, M.D., associate professor of Obstetrics and Gynecology at SUNY Upstate Medical University in Syracuse, NY. Women with high-risk a heart condition should always get expert counseling before they conceive, as well as specialized prenatal care to help increase their odds of having a healthy pregnancy.

How Pregnancy Affects Your Heart
Preparing for Pregnancy With a Heart Condition
Your Pregnancy Risk With Specific Heart Conditions

How Pregnancy Affects Your Heart

Your heart has to pump 40 percent more blood to all of your organs during pregnancy, which means it has to work that much harder than normal. Your blood vessels dilate to accommodate the increased blood flow, lowering your blood pressure, and your blood becomes more likely to clot, which is nature’s way of protecting pregnant women from excessive bleeding during childbirth. “A normal heart can handle those changes just fine,” Dr. Martin says. “But I tell my patients who have heart issues that pregnancy is like a nine-month treadmill stress test.”

Preparing for Pregnancy With a Heart Condition

Plan ahead, if possible. Go to your ob-gyn, explain that you’re thinking about becoming pregnant, and discuss any testing that you might need. Your doctor may advise that you meet with a maternal fetal medicine expert (someone who specializes in high-risk pregnancies) and/or a cardiologist, who will want to know how you function day-to-day with your heart condition. “The most important thing to do when evaluating a patient before or during pregnancy is assessing whether they are able to do their normal, daily activities,” Dr. Folk says. “If you can do all the things you normally would do, including keeping up with exercise and being athletic, and you have that kind of high-functional status, there is a very high likelihood of doing well and having a nice delivery at term.” If your daily activity is restricted, doctors can use several different rating systems to determine whether you’re able to have a safe pregnancy.

Your Pregnancy Risk with Specific Heart Conditions

Conditions that shouldn’t stop you from getting pregnant
Many women with the following heart conditions can have a healthy pregnancy, even if doctors have advised them otherwise.

Heart Murmur: A heart murmur is an extra sound heard during a heartbeat, and it’s very common. (In fact, some women develop one during pregnancy because of the increase in blood volume, Dr. Martin says.) If you have a murmur, talk to your doctor about whether you need to be evaluated further.

Arrythmias: Arrythmia is a technical word for an irregular heart rate. Some can worsen during pregnancy because your heart is working harder, or even develop for the first time, Dr. Martin says. Often, they require no treatment, but there are medications that can be safely used to treat an arrythmia during pregnancy, if necessary.

Mitral Valve Prolapse: This common condition occurs when the valve separating the upper and lower chambers of the heart does not close properly. “It can cause heart palpitations or it can be completely asymptomatic,” Dr. Martin says. Rarely, it can cause an infection of the lining of the heart, abnormal heart rhythms, or, for severe mitral valve prolapse, congestive heart failure during pregnancy — but these complications can be safety treated with medication during pregnancy.

High Blood Pressure: “As more and more women are delaying pregnancy until later in life, high blood pressure is one of the most common medical conditions managed in pregnancy,” says Chad Klauser, M.D., perinatologist and clinical assistant professor at the Mount Sinai School of Medicine in New York City. The greatest risk for pregnant patients who have high blood pressure is developing preeclampsia, but many of these women have uneventful pregnancies or preeclampsia that can be managed until the baby reaches a safe gestational age for delivery. Women contemplating pregnancy should review their current medications with their obstetrician to ensure that the antihypertensive agent they are on is safe to use during pregnancy, Dr. Klauser adds.

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