Maternal heart disease complicates approximately 1% of all pregnancies and is a leading cause of maternal deaths.
Depending on the nature of the condition, the prognosis and recommendations for treatment vary.
The risk of complications during pregnancy and childbirth vary by the type and severity of the heart condition affecting a mother. Congenital heart disease is the most common type of cardiovascular disease. 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.
However, women born with congenital defects might have arrhythmia (irregular heart rhythm), hypertension (high blood pressure), and an increased risk of infection. Patients with pulmonary hypertension are usually advised not to conceive, whereas other conditions are generally much better tolerated with fewer pregnancy complications.
Because treatment options vary, it is extremely important to have a full evaluation by a cardiologist and Maternal Fetal Medicine specialist prior to pregnancy to help determine whether becoming pregnant is safe, and what treatments and testing might be required during pregnancy to optimize outcomes for you and your baby.
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.
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. Your team of specialists will work closely together to develop a comprehensive treatment plan that best meets your needs.
Additionally, patients with cardiac disease have an increased risk of giving birth to children with cardiac anomalies (approximately 5-10%). Therefore, fetal echocardiography is recommended in pregnancy to evaluate the structure and function of the fetus’ heart. This is a specialized ultrasound test that evaluates the fetus’ heart using sound waves.
For those with significant heart disease, labor and delivery might need to be monitored more closely than usual. If delivering vaginally, forceps or vacuum extractors might be used to reduce the need for pushing and exertion. Heart disease usually does not necessitate cesarean delivery, but in certain instances (like preterm or spontaneous birth), a cesarean might be safer for you or your baby.
Not all heart disorders during pregnancy are present prior to becoming pregnant. In some cases, people develop conditions during pregnancy, to varying degrees of severity. The most frequent heart condition that develops in pregnancy is an arrhythmia, which is a heart rate irregularity. Most of the time this is not harmful to you or your baby, but may need to be evaluated by a cardiologist to be certain. They typically resolve after birth on their own.
Another common heart condition that pregnant women may develop includes hypertension (high blood pressure). Hypertension can develop in a few different ways. Gestational hypertension and preeclampsia are classified as high blood pressure after 20 weeks gestation. Different treatments are available, depending on when these conditions develop. Your doctor will closely monitor your symptoms and work with you to manage your heart disease for a safe and successful pregnancy.
For more information about management of cardiac disease in pregnancy, contact Maternal Fetal Medicine Associates today. We’re here as your partner in pregnancy, helping keep you and your baby healthy with regular monitoring, screening, and testing. Schedule your pre-conception appointment with us today to learn how your pregnancy may be affected by heart disease, and how we can help you deliver a healthy baby at the right time. Call us or contact us online today to get started.
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!