Heart Disease and Pregnancy: An Uneasy Mix

Planning is essential to manage risks and complications
Heart Disease and Pregnancy

Though having a child might seem like the most natural and healthy thing in the world, pregnancy puts a strain on the mother’s body, in particular on her cardiovascular system.

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Women who have heart conditions should discuss potential risk factors with their doctor before planning a pregnancy. A team of dedicated medical professionals including cardiologists and obstetricians can give sound advice and help assure the best possible outcomes.

Pregnancy boosts the heart’s workload

During pregnancy, changes in the heart and blood vessels increase the heart’s workload.

Blood volume increases, so the heart increases the amount of blood it pumps each minute. Heart rate also increases.

Blood pressure may decrease during pregnancy, which can cause light-headedness, even in healthy women.

Pre-existing heart conditions and pregnancy

Women with a heart condition need to take special precautions before and during pregnancy. Some heart conditions may increase a woman’s risk for complications. In addition, some women may have heart or blood vessel conditions that are not identified until pregnancy.

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In certain cases, doctors might discourage women with congenital heart defects or heart disease from getting pregnant because of the risks involved.

Congenital heart conditions

Atrial (ASD) and ventricular septal defects (VSD), and patent ductus arteriosus (PDA) are the most common congenital heart defects (those that are present at birth).

Patients with these defects have an opening in the septum (the muscular wall separating the right and left side of the heart). If the hole is large, blood from the left side of the heart can flow backward, ending up in the lungs again.

In general, most women with a congenital heart defect, especially those who have had corrective surgery, can safely become pregnant. But, for some women who were born with a heart defect and other complications, pregnancy is not recommended because it’s too dangerous.

High-risk patient

Richard Krasuski, MD, Director of the Adult Congenital Heart Disease Center at Cleveland Clinic, recently helped guide a young woman with a lifelong history of heart disease and an implanted, artificial heart valve through a high-risk pregnancy and successful delivery.

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The dramatic story had a happy ending, though the challenges were particularly daunting. “Patients who have had artificial valves implanted require blood thinners to minimize the risk of blot clots and stroke. These medications are effective, but some increase the risk of birth defects, and all blood thinners raise the risk for excessive bleeding during delivery,” says Dr. Krasuski.

Women who have any kind of valve disease need to be evaluated by a cardiologist before planning a pregnancy. In some cases, surgery to correct the valve may be recommended before pregnancy.

Planning is essential

You should be evaluated by a cardiologist (a heart specialist) before you start planning a pregnancy if you have:

  • Hypertension (high blood pressure) or high cholesterol
  • Prior diagnosis of any type of heart or blood vessel disease
  • Prior heart attack or stroke
  • Poor heart function with reduced pumping ability
  • Heart valve disease (leaking or narrowing)

The cardiologist can provide you with guidance on possible risks and can work with your health care team to monitor your health and your baby’s health during pregnancy. With proper planning and care, most women are able to have a healthy baby and remain healthy themselves.

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