Heart Disease and Pregnancy
Treating Cardiovascular Diseases in Wisconsin and Northern Illinois
During a normal pregnancy, a woman’s blood volume increases by about 50 percent, putting extra stress on her heart and blood vessels. This excess blood volume can lead to many symptoms that mimic traditional heart disease, such as a racing heart, heart mumurs and leg swelling.
Sometimes this increased blood volume causes a drop in hemoglobin levels, causing anemia and related symptoms, such as shortness of breath, chest pain, fatigue and dizziness. Other women may experience dizziness or lightheadedness when hormone changes cause a drop in blood pressure as more blood is directed toward the uterus.
Although these often are normal symptoms during healthy pregnancies, women who experience them should contact their doctors about these concerns.
Pre-existing Heart Disease and Pregnancy
Women who have pre-existing heart conditions may experience more heart disease symptoms or complications from this added blood volume. To help ensure a safe pregnancy and delivery—as well as a healthy baby—women with any of the following conditions should see their cardiologist before, during and after their pregnancy.
High Blood Pressure in Pregnancy
High blood pressure, also known as hypertension, can be dangerous for both the mother and the fetus. While some women have high blood pressure prior to becoming pregnant, others can develop it during their pregnancy, a condition known as gestational hypertension.
The effects of high blood pressure during a pregnancy can range from mild to severe. In some cases, high blood pressure can cause swelling and harm the mother's kidneys and other organs. It can also lead to a baby’s low birth weight and early delivery.
High blood pressure sometimes leads to preeclampsia, or "toxemia of pregnancy," a condition that can threaten the lives of both the mother and the fetus. Preeclampsia typically starts after the 20th week of pregnancy and affects the placenta. It can also affect the mother's kidneys, liver and brain. Preeclampsia is a leading cause of fetal complications, including low birth weight, premature birth and stillbirth. Most often it can be safely treated with bed rest and medications.
When preeclampsia causes seizures in a woman, the condition is known as eclampsia, which is the second leading cause of maternal death in the United States. However, most women who develop signs of preeclampsia are closely monitored to lessen or avoid related problems. The only way to "cure" preeclampsia is to deliver the baby.
Congenital Heart Defects and Pregnancy
Women with congenital heart defects should talk with their doctors about potential health risks before becoming pregnant. Learn more about congenital heart disease symptoms.
Many women who have simple heart defects or had their defects corrected with surgery can have normal pregnancies and deliveries. However, pregnancy is not usually recommended for women who have a congenital heart defect that’s associated with pulmonary hypertension (high blood pressure in the lungs).
Women who have congenital heart defects have a greater chance of having babies with congenital heart disease. In some cases, it is helpful to have fetal echocardiography (echo), an imaging test that uses sound waves to show the size and shape of the baby's heart and how well the heart’s chambers and valves are working.
Marfan Syndrome and Pregnancy
Marfan syndrome is a connective tissue disorder that often affects the heart and blood vessels. Learn more about the symptoms of Marfan syndrome.
Many pregnant women with Marfan’s have safe and normal pregnancies and deliveries. However, this condition has some added risks due to the extra strain on the heart during pregnancy, and during labor and delivery as the woman pushes.
The most serious risk is an aortic dissection, a potentially life-threatening condition that occurs when there is bleeding into and along the wall of the aorta (the major artery carrying blood out of the heart). If you have Marfan syndrome, you should see a cardiologist to evaluate your potential risks before becoming pregnant.
Women with Marfan’s have a 50 percent chance of passing the condition to each child they have. Even if you pass the gene on, your child's symptoms may be different than yours. You may want to consult with your doctor or a geneticist about any potential risks.
Valve Disease and Pregnancy
Women with aortic valve stenosis or mitral valve stenosis should see a cardiologist before planning a pregnancy. Valve stenosis is a condition in which a valve has narrowed, causing the heart to work harder to pump through the narrowed valve.
Aortic valve stenosis can cause the left ventricle (main pumping chamber) to enlarge, which can lead to heart failure. Women with mitral valve stenosis can develop atrial fibrillation (a type or irregular heartbeat), when the left atrium enlarges. To avoid these conditions, some women are advised to have their valves repaired or replaced before becoming pregnant.
Most women with mitral valve prolapse can tolerate pregnancy. However, women who have artificial valves and are taking blood thinners should see a cardiologist before planning a pregnancy.
Arrhythmias and Pregnancy
Arrhythmias, or irregular heartbeats, may occur more frequently during pregnancy due to a woman’s increased blood volume and hormone changes. After determining the type of arrhythmia, your physician is likely to perform various tests to determine its underlying cause and any potential risks.
Most arrhythmias in pregnancy are treated conservatively. If your symptoms are minimal, your doctor may recommend rest and special vagal maneuvers, which are simple exercises that help slow your heart rate.
When the arrhythmia causes symptoms or a drop in blood pressure, antiarrhythmic medications are sometimes prescribed; but whenever possible, they’re avoided during the first trimester to limit risks to the fetus.
Cardioversion, a procedure that uses electrical shock to restore a normal heart rhythm, is considered safe during a pregnancy.
Heart Attack During Pregnancy
A heart attack is very rare during pregnancy. Most occur during the third trimester and may be treated effectively with medication. If necessary, angioplasty and stenting can be successfully performed, as long as the fetus is shielded during the procedure.
Diagnosing Heart Disease During Pregnancy
When heart concerns arise during pregnancy, the following noninvasive tests can be safely performed:
- Echocardiogram (echo) or stress echo
- Electrocardiogram (EKG) or Stress EKG
- Chest X-rays
- Lab testing
A Leader in Treating Heart Disease in Pregnancy
Aurora Health Care often uses multi-disciplinary teams to treat women with heart problems during pregnancy. Our cardiologists regularly collaborate with obstetricians, pediatricians and cardiac pediatricians to prevent and treatheart disease in pregnancy and to help ensure a healthy baby.
Aurora doctors are conveniently located throughout eastern Wisconsin and northeastern Illinois. Find a doctor or heart specialist near you. To get a second opinion or if you need assistance finding a provider, please call 888-649-6892.