More than 60 million women in the United States are living with some form of a heart condition. Heart disease claims one in every five female lives and is the leading cause of death among women. 

And heart disease can be especially dangerous during pregnancy. 

As heart rate increases and blood pressure changes, the extra cardiac work from carrying a baby can complicate preexisting heart conditions.

While many women may be looking forward to the milestone of having a baby, they may also have questions about the potential impacts of heart disease during pregnancy.

Understanding the signs and symptoms can lead to early detection and intervention. 

By prioritizing heart health before, during and after pregnancy, women can ensure a healthier future for themselves and their baby.

Experts from University of Michigan Health helped answer an array of questions during a live discussion. 

The panel included Timothy Cotts, M.D., a cardiologist who specializes in adult congenital heart disease, and Elizabeth Langen, M.D., a maternal-fetal medicine specialist and the maternal-fetal medicine director of the cardio-obstetrics program.

See summaries of experts' responses below or watch the full Q&A discussion on pregnancy and heart health.

Before pregnancy

Is it safe to get pregnant if I have a heart condition?

Langen: Pregnancy is always a risk factor to health and you’re always more likely to have medical problems while pregnant. But it really depends on the specific cardiac condition that a person has. 

We try to assess whether they have a small added risk compared to the general population or if their heart condition is serious enough that we recommend other options like surrogacy or adoption.

It’s important that patients with underlying heart disease make the choice about when to get pregnant in partnership with their cardiologist to optimize their health and medications. 

If they are already pregnant, it’s vital that they reach out to a cardiologist right away to monitor the rest of the pregnancy.

Can pregnancy make my heart condition worse?

Cotts: We certainly see a higher risk for cardiac events over the course of a pregnancy. 

There are situations where we can see decreased heart function in pregnant women. The risk for serious events, such as death, is, fortunately, very low, even in patients with serious heart conditions.

Are some preexisting conditions particularly high risk?

Langen: Anybody with a heart disease, a heart transplant or a congenital heart disease should take certain precautions before getting pregnant.

But there are a few groups that may be particularly high risk, including people with connective tissue disorders, pulmonary hypertension or a history of peripartum cardiomyopathy. These are among the few situations where we might discourage a pregnancy.

Is there an age at which pregnancy is no longer recommended?

Langen: We know that as people get older they are at higher risk for cardiovascular complications associated with pregnancy. 

For patients with heart conditions, it may be better to get pregnant younger when you have better cardiovascular functioning.

However, there may be some situations where surgery is needed prior to pregnancy and may push back your timeline for getting pregnant. 

Having better cardiac function when you start pregnancy outweighs any risk from being a couple years older.

Is there a time during pregnancy when the risks are higher?

Cotts: There is an increased risk over the course of pregnancy, particularly at the time of labor and delivery. 

It’s also important to note that the risk does not completely go away after delivery. We worry about the early postpartum period when serious concerns can still come up, but our patients are now at home and no longer being closely monitored in the hospital. 

If you have a concern, reach out to your cardiologist immediately.

If I have a heart condition, will my baby get it too?

Cotts: This is something that gets discussed during the preconception visit and is unique to each individual’s heart problem. 

In the general population, the risk of having a baby with a heart problem is around 1%. For people with heart defects, we know that the odds are slightly higher at 2-3%. 

In these cases, we recommend that the mother has a specialized ultrasound done to make sure the baby doesn’t have a heart issue.

During pregnancy

How to relieve chest tightness during pregnancy?

Langen: Chest tightness can be both a normal symptom of pregnancy and an indicator of heart issues. 

If this chest tightness is new or feeling different, it’s important to talk about it with your care team. They will help evaluate the symptom and develop a treatment plan.

Is it normal for heart rate to increase when pregnant?

Langen: Everyone’s heart rate increases during pregnancy, typically rising about 10 beats per minute. 

A typical pregnant person can have a heart rate of up to 105 beats per minute. There isn’t a specific heart rate cutoff that concerns us; instead, we would look for drastic changes in heart rate throughout the pregnancy. 

Patients with an abnormal heart rate, or an arrythmia, should consult with their cardiologist.

Can pregnancy cause heart palpitations?

Cotts: We certainly watch out for heart palpitations, as it is a common symptom that pregnant women can have. 

These palpitations can feel very different from person to person. Typically, it isn’t a cause for concern, but we always monitor the situation for those rare cases.

What medications can pregnant women take with heart disease?

Langen: In an ideal situation, always talk with a cardiologist prior to a pregnancy about the current medications you’re on. They will help make any adjustments if necessary.

There are really only a few medications that we are concerned about, such as specific blood pressure medicines. That being said, don’t just stop your medications altogether if you get pregnant − most likely, it will be safe to continue with your usual regimen.

Can pregnancy cause me to have heart failure?

Cotts: It’s relatively rare for a patient with a healthy heart to develop heart failure. Known as peripartum cardiomyopathy, this rare condition can weaken the heart during the last month of pregnancy or within the first few months postpartum. 

We monitor symptoms like shortness of breath and swelling in the legs to see if an evaluation for peripartum cardiomyopathy is necessary.

For patients with an existing heart problem, we are aware of this risk from the start and continuously monitor for heart failure. Even among these groups, it is a rare outcome and the odds are more likely that they will have uncomfortable symptoms but never reach heart failure.

What is the birth process like if I have a heart problem?

Langen: The birth plan is developed in detail and can help anticipate issues so there are no surprises.

For each individual case, we discuss risk factors, certain drugs to avoid and potential birth plan alterations accounting for the preexisting heart condition. There are lots of ways that we can safely guide people through the birthing process. 

There have been multiple studies that have shown people with heart disease do just as well with a vaginal birth as opposed to a cesarean birth. 

Of course, there are a few unique exceptions, but for most people we generally recommend a vaginal delivery. One thing we always recommend for patients with cardiovascular disease during labor and delivery is epidural anesthesia. This can help ease some of the stress response and keep their cardiovascular work steady.

Postpartum

What are worrisome symptoms that I should look for after delivery?

Cotts: Swelling in the legs, shortness of breath, difficulty lying flat and heart palpitations are all signs to watch out for. 

This is especially true if these symptoms are continuing to get worse after delivery rather than improving.

Can postpartum depression exacerbate my heart disease?

Langen: Postpartum depression and anxiety are very common disorders that anyone can have after delivery. 

While there is no specific correlation between postpartum depression and heart disease, it’s very important to pay attention to those symptoms for your mental and physical health. 

Struggling with something like postpartum depression can impact how much attention you are giving to managing your heart disease.

Resources

• For more information, visit the U-M Health Cardio-Obstetrics Program

• To make an appointment, call 734-763-6295

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