AFib in pregnancy requires careful monitoring and management to ensure maternal and fetal well-being.

Atrial fibrillation (AFib) is a type of cardiac arrhythmia in which the heart’s upper chambers (atria) beat irregularly, often too fast. This causes an irregular, and sometimes rapid, heart rhythm.

AFib developing during pregnancy is relatively rare. It can be mild with no symptoms at all. Other times, it can be more serious. In these cases, people may have symptoms that significantly affect their daily life.

Closely monitoring AFib can help you stay on top of any potential complications during pregnancy and beyond.

It’s possible to have a healthy pregnancy with AFib, but the condition does pose potential risks for both the mother and the developing fetus.

The main concerns with AFib during pregnancy are:

  • Blood clot risk: Pregnancy raises the risk of blood clots. When combined with AFib, this risk theoretically increases further, potentially leading to complications.
  • Blood flow changes: AFib can cause rapid changes in heart rate and circulation. These changes might challenge the cardiovascular system during pregnancy, potentially affecting maternal and fetal health.
  • Medication: Certain AFib medications may pose risks during pregnancy, requiring potential adjustments or changes to ensure safety for both the mother and the fetus.

Pregnancy with AFib requires comprehensive planning, regular checkups, and teamwork among specialists to ensure the best possible outcomes.

AFib developing during pregnancy is relatively rare.

However, pregnancy brings significant changes to the body, like increased heart output, expanded blood volume, and adjustments in heart size, rate, and blood flow resistance.

These changes may predispose pregnant people to new cardiac arrhythmias or worsen preexisting ones.

One 2016 study assessed the prevalence of AFib and atrial flutter in pregnant participants and their effects on maternal and fetal outcomes.

Over a decade, among 264,730 pregnancies, AFib was found in 157 cases, resulting in a low prevalence.

Older age and white race were associated with higher AFib odds, especially in the third trimester. Adverse maternal cardiac events were rare: There were only two cases of heart failure. No strokes, embolic events, or maternal deaths occurred.

Most pregnancies resulted in live births with similar birth weights, but there was a slightly higher rate of neonatal intensive care unit (ICU) admissions among atrial flutter cases.

Overall, while atrial flutter in pregnancy is rare and linked to certain factors, severe complications for both mothers and babies are infrequent but remain a concern.

Several factors can increase the likelihood of developing AFib, including:

  • Age: The risk of AFib increases as you get older, especially beyond age 60 years.
  • Heart conditions: Various heart issues, like high blood pressure, congenital heart defects, and heart failure, can contribute to AFib.
  • Other chronic conditions: Chronic conditions, such as obesity, diabetes, lung diseases like chronic obstructive pulmonary disease (COPD), and thyroid problems such as hyperthyroidism, can increase the risk.
  • Family history: If someone in your immediate family has had AFib, your risk may be higher.
  • Lifestyle factors: High alcohol use, smoking, and substance use can increase the risk.
  • Sex: Males generally have a higher risk of developing AFib than females. However, emerging evidence suggests females with certain risk factors, such as obesity, high blood pressure, and diabetes, may also have a higher risk.
  • Anxiety and stress: Evidence suggests anxiety disorders or chronic stress can sometimes trigger AFib episodes in people at risk.

During pregnancy, females with a history of any arrhythmias before getting pregnant have a greater risk of cardiac events, such as:

  • recurrent arrhythmias
  • heart failure
  • stroke
  • heart-related death

Diagnosing AFib during pregnancy involves similar procedures to those used in nonpregnant individuals.

A doctor may perform or order the following:

  • Medical history and physical exam: Your doctor reviews your symptoms and checks for an irregular heartbeat.
  • Electrocardiogram (EKG): This test records your heart’s electrical activity to detect irregular rhythms.
  • Holter monitor or event recorder: You wear a portable device to track heart activity for longer periods to capture intermittent AFib episodes.
  • Echocardiogram: Using sound waves to create images of the heart, this test assesses your heart’s structure and function to identify AFib causes.

While the core diagnostic tools used for AFib in pregnant and nonpregnant people are similar, doctors might adjust their approach during pregnancy.

For example, they may monitor you more closely and take extra precautions to accurately diagnose and manage AFib during pregnancy.

Managing AFib during pregnancy involves a cautious approach focused on both maternal and fetal safety.

Effective AFib management often involves:

Medication adjustments

Your doctor may adjust or substitute some medications used for AFib during pregnancy.

For example, certain beta-blockers, like metoprolol and propranolol, are among the medications considered safer for pregnant people with AFib.

Some blood thinners are considered unsafe during pregnancy, so your doctor may switch you to warfarin or low molecular weight heparin, depending on your stage of pregnancy.

Monitoring and regular checkups

Close monitoring of heart rhythm, blood pressure, and overall health throughout pregnancy is essential. Regular checkups with your care team help ensure timely treatment adjustments and assess potential risks.

Collaborative care

Collaboration between obstetricians and cardiologists is necessary to tailor treatment plans. You and your care team can balance managing your AFib and safeguarding fetal health.

AFib medications to avoid during pregnancy

The following AFib medications may pose risks to the developing fetus. During pregnancy, they’re generally avoided or used cautiously:

  • Warfarin: This medication is known to cross the placenta and may cause birth defects when used at higher doses in the first trimester. Warfarin doses under 5 milligrams in the first trimester are safe.
  • Amiodarone: This medication is used to control irregular heart rhythms, including AFib. It’s associated with fetal thyroid and other developmental issues. It’s generally avoided during pregnancy unless no alternative options exist.
  • Direct oral anticoagulants (DOACs): There’s not enough evidence on the safety of DOACs (dabigatran, rivaroxaban, apixaban, edoxaban) during pregnancy.

During labor with AFib, the risk of blood clots increases. There’s a chance AFib symptoms might worsen. Educating yourself about AFib during pregnancy and labor and preparing for delivery is essential.

You can prepare for labor with AFib by:

  • discussing your condition with your birth team
  • creating a birth plan addressing AFib considerations
  • reviewing AFib medications for safety during childbirth
  • staying informed about potential symptoms and concerns
  • talking with your doctor about when to transition your blood thinners before delivery

If you’re pregnant and have AFib, it’s important to be vigilant about any changes in your symptoms. Contact your doctor right away if you experience:

  • rapid or irregular heartbeat
  • shortness of breath
  • chest discomfort or pain
  • fainting or dizziness
  • fatigue or weakness
  • reduced fetal movement

Most people with AFib have healthy pregnancies. Monitoring and addressing any changes in symptoms or heart rhythm are crucial.

Getting regular checkups during pregnancy, adjusting medications under your doctor’s guidance, and discussing any concerns with your care team are key for a positive outcome.