Pregnancy and Your Heart: Are Your Medicines Safe for Your Baby?

Work closely with your doctors for a healthy pregnancy
Pregnancy & Heart Medications

Pregnancy is an exciting time. But if you have a heart condition, it’s also sometimes a worrisome time. You may wonder how you can safely manage your heart medications while you’re carrying your baby.

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Rest assured, having a heart condition doesn’t mean you can’t have a healthy pregnancy and baby. The key is to work closely with your doctors to get a better idea of the risks. They will help you monitor your medications and your body while your baby develops and grows.

Planning before pregnancy is best

Ultimately, the key to a healthy, safe pregnancy is having a detailed discussion with your doctors before you conceive. Ideally, your obstetrician should work with your cardiologist to manage your pregnancy.

Each pregnancy is unique, says cardiologist David Majdalany, MD, Director of Cleveland Clinic’s Adult Congenital Heart Disease Center. Some women are born with heart disease, which is called congenital heart disease, and some develop it later in life, which is called acquired heart disease, such as irregular rhythm, heart failure, or heart attack.

If you have cardiopathy, in which the heart muscle is weakened, it’s a good idea to be evaluated before you get pregnant. That’s because one of the main types of  medications for cardiomyopathy — ACE inhibitors or angiotensin receptor blockers — are not safe to take during pregnancy, Dr. Majdalany says. But you can switch to a pregnancy-safe alternative.

“Do pregnancy counseling to discuss your individual risks,” Dr. Majdalany says. “Talk about the safety of all your medications, think about all your options and be sure you work closely with your care team.”

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How pregnancy affects your heart

Pregnancy puts extra demands on your heart, no matter how healthy you are. The effects may include:

  • Increasing blood volume by 40 percent
  • Boosting cardiac output by as much as 50 percent
  • Thickening your blood, which may raise the risk of blood clots
  • Boosting heart rate between 10 and 20 beats per minute
  • Decrease in blood pressure

If you get your heart checked out before you conceive, you’ll have a better idea of how your body will handle the stress, Dr. Majdalany says. Echocardiograms, cardiac MRIs and stress tests can help your doctors determine the best ways to manage your medications.

Knowing whether your medications are safe 

As for your heart medications, researchers are still studying heart drug safety during pregnancy. They do know, however, that some drugs can cross the placenta and may affect your baby.

These medicines pose the biggest risks to your baby during your first trimester. Managing these medications properly reduces your chances of premature birth or developmental problems for your baby. That’s why it’s best to talk with your doctor before you get pregnant, Dr. Majdalany says.

Your dose could change as your body does 

The blood-volume increase during pregnancy affects how your kidneys and liver process your heart medicines. So your doctor may need to change your heart medicine doses.

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In many cases, doctors consider beta-blockers, diuretics and calcium channel blockers safe to take during pregnancy. Your doctor can confirm whether you’re taking the right amount.

Your doctors also may prescribe alternative drugs to take during your pregnancy.

For example, there are substitutes for the blood thinner warfarin, which the Food and Drug Administration does not recommend taking early in pregnancy. Your doctor might suggest heparin injections for your first trimester before switching back to warfarin until delivery nears.

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