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Heart disease in pregnancy is something to take seriously. According to the American College of Obstetrics and Gynecology (ACOG), in the United States, cardiovascular disease is the leading cause of death during pregnancy and postpartum, causing 4.23 deaths for every 100,000 births.

But there’s hope. If heart disease is recognized early and treated with comprehensive medical care, many of these deaths can be prevented. It’s possible to have a successful pregnancy as someone with heart disease.

Here’s what to know about heart disease in pregnancy, including signs and symptoms, risk factors, treatment options, and what the outlook looks like for both parents and their babies.

Overall, heart disease is present in about 1% to 4% of pregnancies. Heart conditions that can affect pregnancy may be divided into two main categories:

1. Preexisting heart conditions:

Preexisting cardiac conditions that may adversely affect pregnancy include:

2. Heart conditions that develop during your pregnancy:

Certain heart conditions may develop before pregnancy or during the course of pregnancy, such as:

If you’ve had a history of heart disease before pregnancy, a healthcare team will be on high alert for signs and symptoms that your condition has become exacerbated. At other times, certain new signs and symptoms may alert you of an emerging heart condition.

Either way, any of the following symptoms may indicate that a heart condition is affecting your pregnancy:

It’s important to keep in mind that some of these symptoms — such as exhaustion or dizziness — are common even in typical pregnancies. If you have symptoms, talk with an OB-GYN or nurse midwife, in case further testing or observation is needed.

The causes of heart disease in pregnancy depend on several factors. For some people, preexisting health conditions may put them at higher risk of developing heart disease during pregnancy. Additionally, the changes your body undergoes during pregnancy may increase the risk of cardiac events.

Some underlying medical conditions may increase your risk of developing heart disease during pregnancy. These include hypertension and diabetes. The reasons that people develop specific heart conditions in pregnancy vary, and experts are still learning how pregnancy affects the chances that you’ll develop these diseases.

Cardiomyopathy and coronary artery disease in pregnancy are caused by many of the same elements that cause these diseases in nonpregnant people. However, when it comes to myocardial infarction (a heart attack), certain pregnancy conditions may increase risk, including preeclampsia and eclampsia.

It remains unknown why certain pregnant people develop valvular disease, but some forms of valvular disease are worsened by the fluid shifts and changes during pregnancy and may become unmasked.

Whatever the case, it’s known that pregnancy in and of itself increases the work that your heart needs to do. This means that any underlying heart conditions you have can become worse during pregnancy, and this may be part of the reason pregnant people are at higher risk of developing new heart conditions.

Here’s what happens to your cardiac system during pregnancy:

  • your cardiac output (how much blood your heart pumps) increases up to 45%
  • your heart rate increases 20% to 25%
  • your systemic vascular resistance (the amount of force exerted on blood circulating) decreases by about 35% to 40% during pregnancy
  • your blood pressure typically drops in early pregnancy but may increase toward the end of pregnancy

Symptoms that indicate a possible emerging cardiac condition should be taken seriously. If you present with any troubling symptoms, it’s likely that an OB-GYN or midwife will want to perform a few tests to evaluate what might be going on.

For example, you might get blood work done, and you might have your urine tested. Blood tests may include labs such as:

These tests may look for differences that may indicate cardiac issues, such as liver enzyme or kidney abnormalities.

From there, certain tests that look at the activity of the heart may be called for. These include:

  • Electrocardiogram (ECG or EKG): An electrocardiogram records electric signals from the heart using electrodes placed on the chest and can be used in the evaluation of arrhythmias.
  • Echocardiogram (ECHO): An echocardiogram is an ultrasound of the heart that produces images and is used to look at the heart muscle and valves.

Treatment for heart disease in pregnancy depends on the cause and when in pregnancy the conditions become apparent.

If you go into pregnancy with known heart disease, you’ll likely be seen by a team of healthcare professionals, including a cardiologist, during the entire duration of your pregnancy to monitor your symptoms.

Your pregnancy may be considered a high risk pregnancy. This means that you’ll receive extra care along the way to ensure you and your baby stay healthy.

People who develop heart issues during pregnancy will also need to be monitored carefully. That means that you should attend all of your prenatal appointments as well as appointments with heart specialists.

The care team may give you instructions on what to eat, inform you about what exercise or physical movement is appropriate, and provide other strategies to keep you well.

Sometimes cardiac issues in pregnancy are managed with medication. The type of medication used will vary based on what condition you have and what medications are safe for pregnancy. The healthcare team will weigh the risks and benefits of any medications during pregnancy.

There are certain factors that may put you at higher risk of experiencing a serious heart disease in pregnancy. According to ACOG, these include:

  • Race: Black parents are 3.4 times more likely to die from cardiovascular disease in pregnancy than white parents. One reason for this may be inequities in healthcare.
  • Age: People over the age of 40 years are 30 times more likely to die of heart disease in pregnancy than people younger than 20 years.
  • High blood pressure: Developing hypertension in pregnancy increases your risk of experiencing a cardiac event either during or after pregnancy.
  • Obesity: People who have obesity before and during pregnancy are more likely to experience adverse cardiac events.

Heart disease in pregnancy is a serious matter and can have devastating effects if pregnant people don’t receive adequate medical care.

According to the Centers for Disease Control and Prevention (CDC), in the United States, the overall maternal mortality was 23.8 per 100,000 births in 2020, with the majority of those who died being people with cardiovascular disease.

Still, many people with heart disease go on to have healthy pregnancies. If a heart condition in pregnancy is diagnosed, you should stay in close touch with the care team, attend all medical appointments, and follow their care recommendations. This will decrease your overall risk of significant cardiac complications.

It’s also vital to stay in touch after pregnancy, as pregnancy-related cardiac events can happen in the postpartum period as well. Some cardiac issues resolve soon after pregnancy, but some people may experience an increased risk for a longer duration.

Always report any cardiac symptoms or concerns to a healthcare professional, and don’t be afraid to advocate for yourself.

If you know you have heart disease and are hoping to become pregnant in the future, it’s important that you receive preconception counseling. Most heart conditions can be well managed during pregnancy, but some conditions may mean that pregnancy isn’t right for you.

For example, the World Health Organization (WHO) says that conditions like severe ventricular dysfunction, significant widening of the aorta, pulmonary arterial hypertension, and underlying connective tissue disease put you at the highest risk of adverse outcomes.

Heart disease in pregnancy can affect babies in various ways. For example, there’s an increased chance of stillbirth or preterm birth among babies whose birthing parents have heart disease in pregnancy. These babies are also more likely to develop heart disease later in life.

Keep in mind that protecting yourself from serious outcomes also protects your baby. So, if you have heart disease in pregnancy, make sure to follow a doctor’s or midwife’s health recommendations, attend all medical appointments, and take medication if needed. This is the best way to keep your baby safe during pregnancy.

How often is medication prescribed for heart disease in pregnancy?

According to ACOG, medication is prescribed in about one-third of people who experience heart disease in pregnancy. Doctors prescribe these medications carefully, weighing the risks and benefits during pregnancy and for the fetus.

How does hypertension affect heart disease in pregnancy?

Experiencing hypertension (evaluated blood pressure) in pregnancy increases your risk of cardiac events. For example, your risk of a heart attack increases 13-fold and your risk of heart failure increases 8-fold.

Does peripartum cardiomyopathy go away on its own?

People who develop peripartum cardiomyopathy, a condition in which your heart becomes weakened during your pregnancy, are often able to make a full recovery after pregnancy. About 72% of people with the condition recover typical ventricular function within a year of pregnancy.

Heart disease in pregnancy is serious, but it’s manageable. There are steps you can take to keep yourself and your baby healthy, including attending all medical appointments, maintaining a heart-healthy lifestyle, and following the care team’s specific instructions for managing your condition.

Finally, be an advocate for your needs and report all new symptoms to a healthcare professional.