Most women who have heart disorders—including certain heart valve disorders (such as mitral valve prolapse Mitral Valve Prolapse (MVP) Mitral valve prolapse is a disorder in which the valve flaps (cusps) bulge into the left atrium when the left ventricle contracts, sometimes allowing leakage (regurgitation) of blood into the... read more ) and some birth defects of the heart—can safely give birth to healthy children, without any permanent ill effects on heart function or life span. However, women who have moderate or severe heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more before pregnancy are at considerable risk of problems. Before becoming pregnant, such women should talk to their doctor to make sure their disorder is being treated as effectively as possible.
For women with some types of heart disorders, pregnancy is inadvisable because it increases the risk of death. These disorders include
Severe pulmonary hypertension Pulmonary Hypertension Pulmonary hypertension is a condition in which blood pressure in the arteries of the lungs (the pulmonary arteries) is abnormally high. Many disorders can cause pulmonary hypertension. People... read more (high blood pressure in the blood vessels of the lungs)
Certain heart birth defects, including some cases of coarctation of the aorta Coarctation of the Aorta Coarctation of the aorta is a narrowing of part of the aorta, the main blood vessel bringing red oxygenated blood from the heart to the body. The aorta narrows, causing the heart to pump harder... read more
An aortic valve with two instead of the normal three flaps and an enlarged aorta
Heart damage (cardiomyopathy Overview of Cardiomyopathy Cardiomyopathy refers to progressive impairment of the structure and function of the muscular walls of the heart chambers. There are three main types of cardiomyopathy: Dilated cardiomyopathy... read more ) that occurred in a previous pregnancy
If women who have one of these disorders become pregnant, doctors advise them to terminate the pregnancy as early as possible.
Pregnancy requires the heart to work harder. Consequently, pregnancy may worsen a heart disorder or cause a heart disorder to cause symptoms for the first time. Usually, the risk of death (to the woman or fetus) is increased only when a heart disorder was severe before the woman became pregnant. However, depending on the type and severity of the heart disorder, serious complications may develop. These complications include accumulation of fluid in the lungs (pulmonary edema), an abnormal heart rhythm, and stroke.
The risk of problems increases throughout pregnancy as demands on the heart increase. Pregnant women with a heart disorder may become unusually tired and may need to limit their activities. Rarely, women with a severe heart disorder are advised to have an abortion early in pregnancy. Risk is also increased during labor and delivery. After delivery, women with a severe heart disorder may not be out of danger for 6 months, depending on the type of heart disorder.
A heart disorder in pregnant women may affect the fetus. The fetus may be born prematurely. Women with certain birth defects of the heart Overview of Heart Defects About one in 100 babies is born with a heart defect. Some are severe, but many are not. Defects may involve abnormal formation of the heart's walls or valves or of the blood vessels that enter... read more are more likely to have children with similar birth defects. Ultrasonography can detect some of these defects before the fetus is born.
If a severe heart disorder in a pregnant woman suddenly worsens, the fetus may die.
The heart’s walls (myocardium) may be damaged (called cardiomyopathy Overview of Cardiomyopathy Cardiomyopathy refers to progressive impairment of the structure and function of the muscular walls of the heart chambers. There are three main types of cardiomyopathy: Dilated cardiomyopathy... read more ) late in pregnancy or after delivery. This time frame is called the peripartum period, and thus, this disorder is called peripartum cardiomyopathy. The cause is unknown.
Peripartum cardiomyopathy tends to occur in women with one of the following characteristics:
They have had several pregnancies.
They are 30 or older.
They are carrying more than one fetus.
They have preeclampsia Preeclampsia and Eclampsia Preeclampsia is new high blood pressure or worsening of existing high blood pressure that is accompanied by excess protein in the urine and that develops after the 20th week of pregnancy. Eclampsia... read more (a type of high blood pressure that occurs during pregnancy).
Peripartum cardiomyopathy tends to occur in subsequent pregnancies, particularly if heart function has not returned to normal. Thus, women who have had this disorder are often discouraged from becoming pregnant again.
Treatment of peripartum cardiomyopathy is similar to treatment of heart failure Treatment Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more , except that angiotensin-converting enzyme (ACE) inhibitors and aldosterone antagonists (spironolactone and eplerenone) are not used.
Heart valve disorders
Ideally, heart valve disorders Overview of Heart Valve Disorders Heart valves regulate the flow of blood through the heart's four chambers—two small, round upper chambers (atria) and two larger, cone-shaped lower chambers (ventricles). Each ventricle has... read more are diagnosed and treated before the women become pregnant. Doctors often recommend surgical treatment for women with severe disorders.
The valves most often affected in pregnant women are the aortic and mitral valves. Disorders that cause the opening of a heart valve to narrow (stenosis) are particularly risky. Stenosis of the mitral valve Mitral Stenosis Mitral stenosis is a narrowing of the mitral valve opening that blocks (obstructs) blood flow from the left atrium to the left ventricle. Mitral stenosis usually results from rheumatic fever... read more can result in fluid accumulating in the lungs (pulmonary edema) and a rapid, irregular heart rhythm (atrial fibrillation Atrial Fibrillation and Atrial Flutter Atrial fibrillation and atrial flutter are very fast electrical discharge patterns that make the atria (upper chambers of the heart) contract very rapidly, with some of the electrical impulses... read more ). Treatment of atrial fibrillation in pregnant women is similar to that in other people, except that certain antiarrhythmic drugs (such as amiodarone) are not used. Pregnant women with mitral stenosis are closely observed throughout pregnancy because mitral stenosis may rapidly become more severe. If required, valvotomy is relatively safe during pregnancy.
Women with severe aortic or mitral stenosis that causes symptoms are discouraged from becoming pregnant.
Treatment of Heart Disorders During Pregnancy
Avoidance of certain drugs during pregnancy
During labor, an epidural injection
Doctors advise pregnant women with a heart disorder to do the following:
Schedule frequent check-ups
Avoid gaining excess weight
Get enough rest
Anemia, if it develops, is promptly treated.
Certain drugs used to treat heart disorders are not used during pregnancy. They include the following:
Certain drugs used to treat abnormal heart rhythms (antiarrhythmic drugs Drugs Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more , such as amiodarone)
Which other heart drugs are continued during pregnancy depends on how severe the heart disorder is and what the risks to the fetus are. For example, warfarin is usually avoided because it can increase the risk of birth defects. However, it may be given to women who have a mechanical heart valve because warfarin reduces the risk that blood clots will form in these valves. Such clots can be fatal.
If the heart is not functioning well, women may be given digoxin (used to treat heart failure), and bed rest or limited activity is advised, beginning at 20 weeks of pregnancy.
During labor, pain is treated as needed. If women have a severe heart disorder, doctors may inject an anesthetic into the lower back—into the space between the spine and the outer layer of tissue covering the spinal cord (epidural space). This procedure is called an epidural injection Pain relief Labor is a series of rhythmic, progressive contractions of the uterus that gradually move the fetus through the lower part of the uterus (cervix) and birth canal (vagina) to the outside world... read more . This anesthetic blocks sensation in the lower spinal cord, reducing the stress response to pain and the urge to push. The purpose is to reduce the strain on the heart. Pushing during labor strains the heart because it makes the heart work harder. Because these women cannot push, the baby may have to be delivered with forceps or a vacuum extractor Operative Vaginal Delivery Operative vaginal delivery is delivery using a vacuum extractor or forceps. A vacuum extractor consists of a small cup made of a rubberlike material that is connected to a vacuum. It is inserted... read more .
An epidural injection should not be used if women have aortic stenosis. A local anesthetic Pain relief Labor is a series of rhythmic, progressive contractions of the uterus that gradually move the fetus through the lower part of the uterus (cervix) and birth canal (vagina) to the outside world... read more or, if needed, a general anesthetic Pain relief Labor is a series of rhythmic, progressive contractions of the uterus that gradually move the fetus through the lower part of the uterus (cervix) and birth canal (vagina) to the outside world... read more is used instead.
Women are monitored closely immediately after delivery and are checked periodically by a cardiologist for several weeks afterward.
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