Heart Problem? Find Out if You Can Still Have a Baby

Risks associated with pregnancy and heart disease
pregnant woman with picture of baby

If you have a heart problem, you may be wondering if that will interfere with plans to start a family. But having heart disease doesn’t necessarily mean you shouldn’t get pregnant.

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In fact, “the majority of women who have heart conditions should be able to successfully carry a pregnancy under the care of a multidisciplinary team,” says cardiologist David Majdalany, MD.

But being pregnant when you have heart disease does come with some risks.

During pregnancy, your heart has to work harder because of changes that happen to the heart and blood vessels. These changes may include:

  • An increase in blood volume (the amount of blood in the body)
  • An increase in cardiac output (the amount of blood pumped by the heart each minute)
  • An increase in heart rate
  • A decrease in blood pressure

These changes help ensure that your baby will get enough oxygen and nutrients.

Before getting pregnant

“If you have heart disease, it’s important that you be evaluated prior to getting pregnant to find out if your heart will be able to tolerate the added strain,” says obstetrician and Head of the Section of Maternal-Fetal Medicine at Cleveland Clinic Jeff Chapa, MD.

“Initially, you’ll want to be evaluated by both a cardiologist and a high-risk pregnancy specialist (obstetrician) who can work together to help you come up with a plan,” he says.

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Dr. Chapa says an evaluation will result in one of three scenarios:

  1. Your doctor may tell you you’re doing well and it’s okay to get pregnant.
  2. You may need treatment of some sort prior to getting pregnant.
  3. You may need to consider alternatives to pregnancy, such as adoption or surrogacy.

“Another reason you should be evaluated before pregnancy if you have heart disease is there are certain heart medications, such as ACE inhibitors and some rhythm control medications, that shouldn’t be taken during pregnancy, ” says Dr. Majdalany.

“So you’ll need to be switched to alternative medications that are safe for the baby. Also, if you’re on long-term blood thinners – for example, Coumadin® – you may need your medication regimen modified. Furthermore, your coagulation parameters will need to be meticulously monitored to avoid maternal and fetal complications,” he says.

When pregnancy may be too risky

Unfortunately, there are some types of heart disease with which pregnancy is too much of a risk. And it may be risky not only to you, but also to the baby.

“If you have significant congestive heart failure and your heart isn’t functioning well in a non-pregnant state, it won’t be able to handle the added strain of pregnancy,” Dr. Chapa says.

Other types of heart disease that would pose too much of a risk during pregnancy include severe cardiomyopathy, left-sided obstruction, pulmonary hypertension, significant/severe valve narrowing, certain irregular heart rhythms, dilated aorta and/or connective tissue diseases such as  Marfan syndrome.

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Heart disease and unplanned pregnancy

“If you have heart disease and are faced with an unplanned pregnancy, see your cardiologist as soon as possible,” says Dr. Majdalany. “You’ll also need to see an obstetrician who has experience working with patients who have heart disease.”

“At Cleveland Clinic, we have a program where patients can be seen by both a cardiologist and a high-risk obstetrician; the two doctors can evaluate you together and help you make good decisions,” Dr. Chapa says. “But no matter where you go for care, make sure your cardiologist and obstetrician are communicating with each other.”

Heart disease symptoms during pregnancy

Many healthy women have symptoms like fatigue, decreased exercise tolerance, heart palpitations, dizziness, swelling of the legs or shortness of breath during pregnancy. These are similar to the symptoms of heart disease.

“If you’re experiencing these symptoms and they seem to be getting worse or are impacting your ability to go about your everyday life, bring them to the attention of your physician,” says Dr. Chapa.

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