Maternal heart disease complicates approximately one percent of all pregnancies, and is a leading cause of maternal deaths. Due to the improved survival for children born with congenital heart disease, many of these children have now grown into adulthood and are becoming pregnant; therefore, congenital heart disease now accounts for more than half of all cardiac disease in pregnancy.
Depending on the nature of the condition, the prognosis and recommendations for treatment vary. As an example, patients with pulmonary hypertension are usually advised not to conceive, whereas other conditions are generally much better tolerated with fewer pregnancy complications.
The cardiac function pre-pregnancy is an excellent predictor of cardiac complications in pregnancy, and is graded based on the New York Heart Association (NYHA) classification:
- NYHA Class I: Asymptomatic
- NYHA Class II: Symptoms with greater than normal activity
- NYHA Class III: Symptoms with regular activity
- NYHA Class IV: Symptoms at rest
In most cases, women with NYHA class I or II can survive pregnancy well and expect positive outcomes. However, women with NYHA class III or IV have higher rates of cardiac events during pregnancy, as well as chances of morbidity, and sometimes even mortality.
Management of Cardiac Disease in Pregnancy
Since all pregnant women undergo many physiologic changes during pregnancy, including increased blood volume, preload, heart rate, cardiac output, decreased afterload, and systemic vascular resistance, there are considerations for each cardiac condition during pregnancy, in labor, and postpartum. Management of complex cases typically involves specialists from the fields of Obstetrics, Maternal Fetal Medicine, Cardiology, Anesthesia, and potentially others.
Additionally, patients with cardiac disease are have an increased risk of children with cardiac anomalies (approximately 5-10%). Therefore, fetal echocardiography is recommended in pregnancy to evaluate the structure and function of the fetus’ heart. For more information about fetal echocardiography and management of cardiac disease in pregnancy, contact Maternal Fetal Medicine today.
Maternal Fetal Medicine blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!