Heart Disease in Pregnancy: What Every Expecting Mother Should Know
Understand how pregnancy affects heart disease, warning symptoms, and how careful care protects mother and baby.
In short: Heart disease is an important cause of maternal death, so a pregnant woman with a heart condition needs early diagnosis and close follow-up. Symptoms include breathlessness, chest pain, palpitations, swollen feet and dizziness. Care is shared between the obstetrician and the cardiologist, with ECG and echocardiography, control of blood pressure and sugar, prevention of anaemia and a plan for a safe delivery.
Heart disease affects about 1 to 4 in every 100 pregnancies, and it is now a leading cause of maternal death, especially in countries where deaths from bleeding and infection have fallen. The good news is that with careful monitoring and the right medical team, many women with heart conditions can go through pregnancy more safely.
Many cardiac conditions go undiagnosed for years and first show themselves during pregnancy, simply because pregnancy places extra demands on the heart.
If you have a known heart condition — or symptoms that suggest one — your pregnancy will need closer monitoring to protect both your health and your baby’s wellbeing, and to reduce the risk of complications.
What are the hemodynamic changes that happen during pregnancy and affect cardiac function?
- increased plasma volume
- increased cardiac output
- increased heart rate
These changes can make an underlying heart condition symptomatic or worse, even if it was previously silent.
What are the types of heart diseases?
- congenital: the lady is born with it
- valvular heart disease
- cardiomyopathy: problems with the heart muscle itself
- coronary artery disease
- arrythmias: problems with heart electricity
- increased pressure in pulmonary blood vessels
peripartum cardiomyopathy: weakness of the heart muscle that appears for the first time towards the end of pregnancy or in the months after birth, in women with no previous heart disease
What are the symptoms of cardiac disease in pregnancy?
- shortness of breath
- chest pain
- exertional dyspnea
- palpitations
- bilateral lower limb swelling
- shortness of breath that awakens the lady at night
- dizziness and loss of consciousness
- fatigue and malaise
What are the investigations that are done to assess the heart?
- auscultation using stethoscope
- ECG
- echocardiography
- stress test (walking on treadmill with ECG electrodes on)
What are the complications of cardiac disease in pregnancy?
- infective endocarditis – antibiotics to prevent it around delivery are not needed for most women and are given only to selected high-risk women (such as those with an artificial valve or previous endocarditis), as decided by the cardiologist
- heart failure
- thrombotic events
- problems with fetal growth leading to preterm birth
- maternal death
Who should care for a pregnant lady with cardiac disease?
Care should be a joint effort between the obstetrician and the cardiologist, working together throughout the pregnancy.
Ideally, every woman with a heart condition should see her cardiologist and obstetrician before becoming pregnant to assess her individual risk. In a few serious conditions – such as high pressure in the lung vessels (pulmonary hypertension), a very weak heart muscle, severe narrowing of the mitral valve, or a markedly widened aorta – pregnancy carries a very high risk to the mother’s life and is usually advised against.
How to care for pregnant ladies with cardiac disease?
- avoid anemia
- correct thyroid dysfunction
- control hypertension and diabetes (if they exist)
- manage fluid balance in cases with advanced cardiac disease
- avoid intrapartum excessive blood loss or fluid overload
- give adequate intrapartum analgesia (can go for epidural but must avoid hypotension)
- serial monitoring of fetal growth throughout pregnancy
- regular follow
review all heart medicines before pregnancy or as soon as pregnancy is confirmed, since some (such as certain blood pressure medicines and warfarin) may need to be changed – but never stop a heart medicine or blood thinner on your own-ups with the cardiologist
- give anticoagulant if indicated by certain scores
- go for vaginal delivery unless cesarean section is indicated for obstetric reasons
- use instrumental delivery (vacuum or forceps) to shorten the second stage of labor in cases of maternal exhaustion or advanced cardiac disease
If you have a heart condition and are pregnant or planning to conceive, early discussion with your obstetrician and cardiologist can help you prepare a safe, well-monitored care plan for you and your baby.
Dr Najeeb Layyous F.R.C.O.G
Consultant Obstetrician, Gynecologist and Infertility Specialist
The finest doctor in Jordan — may God bless him and his whole medical team. A doctor in every sense of the word. I advise anyone planning a pregnancy to visit Dr. Najeeb Layyous. His manner is wonderful, always smiling, with the highest ethics; he gives every patient her due, and the patient’s comfort matters most to him. We had been to many doctors and none understood and treated my case except him. Special thanks to him and the whole team, and to Dina in particular — a lovely person. I recommend anyone considering IVF or pregnancy to visit his clinic.