Most women who have heart disease—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 heart disease is being treated as effectively as possible.
For women with some types of heart disease, pregnancy is inadvisable because it increases the risk of death. These 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 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 , 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 heart disease or cause heart disease to cause symptoms for the first time. Usually, the risk of death (to the woman or fetus) is increased only when heart disease was severe before the woman became pregnant. However, depending on the type and severity of the heart disease, serious complications may develop. These complications include accumulation of fluid in the lungs (pulmonary edema), an abnormal heart rhythm Overview of Abnormal Heart Rhythms 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 , and stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly... read more .
The risk of problems increases throughout pregnancy as demands on the heart increase. Pregnant women with heart disease may become unusually tired and may need to limit their activities. Rarely, women with severe heart disease are advised to have an abortion early in pregnancy. Risk is also increased during labor and delivery. After delivery, women with severe heart disease may not be out of danger for 6 months, depending on the type of heart disease.
Heart disease 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 severe heart disease 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.
The following factors increase the risk of peripartum cardiomyopathy:
Several prior pregnancies
30 years of age or older
Carrying more than one fetus
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 medications (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 Disease During Pregnancy
Avoidance of certain medications during pregnancy
During labor, an epidural injection
Doctors advise pregnant women with heart disease to do the following:
Schedule frequent check-ups
Avoid gaining excess weight
Get enough rest
Anemia Overview of Anemia Anemia is a condition in which the number of red blood cells is low. Red blood cells contain hemoglobin, a protein that enables them to carry oxygen from the lungs and deliver it to all parts... read more , if it develops, is promptly treated.
Certain medications used to treat heart disease are not used during pregnancy. They include the following:
Certain medications used to treat abnormal heart rhythms (antiarrhythmic medications Drugs to Treat Abnormal Heart Rhythms There are many causes of abnormal heart rhythms (arrhythmias). Some arrhythmias are harmless and do not need treatment. Sometimes arrhythmias stop on their own or with changes in lifestyle,... read more , such as amiodarone)
Which other heart medications are continued during pregnancy depends on how severe the heart disease 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 severe heart disease, 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 . 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 Aortic Stenosis Aortic stenosis is a narrowing of the aortic valve opening that blocks (obstructs) blood flow from the left ventricle to the aorta. The most common cause in people younger than 70 years is a... read more . A local anesthetic Pain relief or, if needed, a general anesthetic Pain relief is used instead.
Women are monitored closely immediately after delivery and are checked periodically by a cardiologist for several weeks afterward.
Drugs Mentioned In This Article
|Generic Name||Select Brand Names|
|Cordarone, Nexterone, Pacerone|
|Digitek , Lanoxicaps, Lanoxin, Lanoxin Pediatric|