Heart Disease in Pregnancy - Signs, Risks and Solutions

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Medically Reviewed by Dr. Arti Sharma
Written by Charu Shrivastava, last updated on 14 April 2023
Heart Disease in Pregnancy - Signs, Risks and Solutions

A woman's body undergoes significant physiological changes during pregnancy. Reproductive organs make alterations and adjustments to ensure the offspring's comfort, safety, and nourishment. Hence, the reproductive system is highly impacted during the process. Similarly, the cardiovascular systems experience increased workloads. Heart diseases in pregnancy are fairly common because of these disturbing cycles over nine months. 

During the first trimester, the zygote is yet to develop into a foetus. Hence, a mother’s body makes changes at a slow pace. However, the second trimester can be challenging, often increasing the risks of cardiac disease in pregnancy. What exactly are these diseases? What are the risks involved? What can a person do to overcome these diseases? Read on to discover answers to all these questions in this blog.

Heart Disease and PregnaHeart Diseases in Pregnancyncy

Cardiac diseases in pregnancy refer to heart-related adverse medical conditions that may develop while a woman is pregnant. Such diseases might be pre-existing or may develop during pregnancy.

According to a study, a 1.46% pooled prevalence was recorded for heart diseases among pregnant women in South Asia. This is an evident indicator of the growing concern about heart diseases among expecting mothers and their possible impacts on the foetus. 

Pre-existing heart diseases may make one’s pregnancy difficult and affect the patient in newer ways. While other diseases do not obstruct pregnancy, cardiovascular diseases are the primary reason for death among gestating women.

Those who develop heart diseases while being pregnant might be in the lower risk zone, and such diseases could go away after the phase is over. These are likely to depend on the kind and extent of the disease.

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Pre-existing Heart Diseases That Could Affect Pregnancy

Women with pre-existing heart diseases are at an increased risk of developing a cardiac disease in pregnancy. Some of the common pre-existing heart diseases that can affect pregnancy include:

  1. Cardiomyopathy: The illness known as cardiomyopathy causes the heart muscle to weaken, expand, or stiffen. This makes it difficult for the heart to pump blood efficiently throughout the body.
    During pregnancy, the body's demand for blood and oxygen increases, which can put additional stress on the heart. Women with cardiomyopathy may experience symptoms such as shortness of breath, fatigue, chest pain, and palpitations.
    They also have a higher chance of getting heart failure as well, which happens when the heart cannot pump enough blood to meet the body's requirements. In severe cases, cardiomyopathy can lead to life-threatening complications such as arrhythmias and blood clots.
  2. Aortic Disease: The aorta is the largest artery in the body and carries oxygenated blood from the heart to the rest of the body. Aortic disease refers to conditions that affect the structure and function of the aorta.
    Pregnant women with aortic disease are at an increased risk of developing aortic dissection, which is a tear in the inner layer of the aorta. Aortic dissection can cause severe pain in the chest, back, or abdomen and can be life-threatening if left untreated.
    Other complications of aortic disease during pregnancy include heart failure, arrhythmias, and high blood pressure.
  3. Congenital Heart Disease: Congenital heart disease is a condition that affects the structure and function of the heart that is present at birth. Women with congenital heart disease may experience complications during pregnancy due to the increased demand for blood and oxygen.
    The severity of the condition depends on the type and extent of the heart defect. Some women with mild congenital heart disease may have a relatively normal pregnancy and delivery, while others may experience complications such as heart failure, arrhythmias, and high blood pressure.
  4. Heart Valve Disease: Heart valve disease occurs when one or more of the heart valves do not work properly. The heart valves regulate blood flow in and out of the heart. During pregnancy, the increased demand for blood and oxygen can put additional stress on the heart valves.
    Women with heart valve disease may experience symptoms such as shortness of breath, fatigue, chest pain, and palpitations. They are also at an increased risk of developing heart failure, arrhythmias, and blood clots.
  5. Arrhythmias: Arrhythmias refer to abnormal heart rhythms that can range from mild to life-threatening. During pregnancy, hormonal changes and increased demand for blood and oxygen can trigger arrhythmias in women with pre-existing heart conditions.
    Some arrhythmias may not cause any symptoms, while others can cause palpitations, dizziness, fainting, and shortness of breath. Treatment for arrhythmias during pregnancy depends on the severity and type of the arrhythmia.
  6. Pulmonary Hypertension: Pulmonary hypertension is a condition that affects the blood vessels in the lungs. It occurs when the blood vessels become narrow and stiff, making it difficult for the heart to pump blood to the lungs.
    Women with pulmonary hypertension are at an increased risk of developing heart failure and blood clots during pregnancy. Symptoms of pulmonary hypertension may include shortness of breath, fatigue, chest pain, and swelling in the legs and ankles.

Heart Problems That Could Develop During Pregnancy

The heart is actively involved in multiple anatomical activities of pregnant ladies, which is why most women suffer minor to major heart diseases during pregnancy. Listed below are the most common heart problems among pregnant women:

  1. Blood Volume Alterations: The earliest heart-related irregularity pregnant women can potentially develop increased blood volume. This happens primarily due to two reasons.
    1. One, there is excessive production of hormones by the reproductive organs, and 
    2. Two, because of uteroplacental circulation (the blood flow between the mother's uterus and the placenta, which provides oxygen and nutrients to the developing foetus).
      The blood volume may increase by 40 to 45% in the first trimester and will keep constant or increase further during pregnancy.
  2. Gestational Diabetes: During the second trimester, i.e., after 20 weeks of pregnancy, mothers can develop high sugar levels. Weight gain and insulin resistance are the most common factors affecting the problem and can put the baby and the mother at risk.
  3. ​​Spontaneous Coronary Artery Dissection (SCAD): SCAD is a rare but serious condition in which a tear occurs in one of the blood vessels supplying the heart.
    During pregnancy, hormonal changes and the increased demand for blood and oxygen can increase the risk of developing SCAD. Symptoms of SCAD may include chest pain, shortness of breath, and nausea. Treatment for SCAD during pregnancy may include medications and, in severe cases, angioplasty or bypass surgery.
  4. Increased Cardiac Output: To pump the blood in more volume, the heart will function more efficiently. This efficiency is known as cardiac output.
    However, women do not experience an increase in cardiac output until their third trimester because the baby will grow from a zygote to a foetus only during this time.
    On average, the cardiac output is expected to be increased by 30 to 50 per cent, and it can go up to 60 per cent in the case of twins.
  5. Hypertension: Hypertension, or high blood pressure, is a common condition that can develop during pregnancy. It can lead to complications such as preeclampsia, a serious condition affecting both the mother and the foetus.
    Symptoms of hypertension during pregnancy may include headache, blurred vision, and swelling in the hands and feet. Treatment for hypertension during pregnancy may include medications and close monitoring of blood pressure levels.
  6. Irregularity in Rhythm: Increased cardiac output will, in turn, induce fast heart rhythms. Generally, the heart rate increases by 10 to 20 rhythms in a minute in the third trimester.
    Sometimes, the heart rate is irregular and is known as arrhythmias. In most cases, it is harmless, but if it gets complicated, the same medication shall be given to a pregnant lady as would be given to a regular heart patient.
  7. Myocardial Ischemia: Myocardial ischemia occurs when the heart muscle does not receive enough oxygen and nutrients due to reduced blood flow.
    During pregnancy, the increased demand for blood and oxygen can increase the risk of developing myocardial ischemia.Symptoms of myocardial ischemia may include chest pain, shortness of breath, and fatigue. Treatment for myocardial ischemia during pregnancy may include medications and, in severe cases, angioplasty or bypass surgery.
  8. Peripartum Cardiomyopathy (PPCM): PPCM is a rare but serious form of heart failure that occurs during the last month of pregnancy or in the months following delivery.
    The cause of PPCM is not fully understood, but it is thought to be related to hormonal changes and inflammation. One may experience symptoms of PPCM, like shortness of breath, fatigue, and swelling in the legs and feet. Treatment for PPCM may include medications and, in severe cases, a heart transplant.

Risks Associated with Heart Problems During Pregnancy

Heart problems during pregnancy can increase the risk of maternal and foetal complications, including preeclampsia, caesarean delivery, and long-term health effects. While women may be dealing with the most common heart disease in pregnancy, there are many risk factors that one must be aware of. 

Close monitoring and prompt treatment are important to minimise these risks and ensure the best possible outcomes for both the mother and the foetus. Some of the most highlighted risks associated with heart problems during pregnancy include:

  1. Maternal Complications: Heart problems during pregnancy can increase the risk of maternal complications such as heart failure, stroke, and blood clots. These complications can be life-threatening for the mother and may require hospitalisation or intensive medical care.
  2. Foetal Complications: Heart problems during pregnancy can also increase the risk of foetal complications such as preterm birth, low birth weight, and stillbirth. These complications can be caused by reduced blood flow to the placenta, which can affect foetal growth and development.
  3. Preeclampsia: Preeclampsia is a serious condition that can occur during pregnancy and is characterised by high blood pressure and damage to organs such as the liver and kidneys.
    Women with heart problems are at an increased risk of developing preeclampsia, which can lead to complications for both the mother and the foetus.
  4. Caesarean Delivery: Women with heart problems may be more likely to require a caesarean delivery (C-section) due to the increased risk of maternal and foetal complications.
    C-sections are major surgical procedures that can increase the risk of complications such as infection, bleeding, and blood clots.
  5. Long-term Health Effects: Heart problems during pregnancy can also have long-term health effects for both the mother and the child. Women with heart problems may be at an increased risk of developing cardiovascular disease later in life.
    Children born to mothers with heart problems may be at an increased risk of developing heart problems themselves.

Symptoms of Heart Problems During Pregnancy

Heart diseases in pregnancy do not come unannounced; they always give prior signs. Chest pain, or angina, is the most profound symptom of heart problems during pregnancy. It happens due to a lack of oxygen-rich blood reaching the heart. 

It is difficult to distinguish angina from other kinds of chest pains, but if one feels squeezing, pressure, heaviness, tightness, or pain in the chest, take it as one related to the heart. Other symptoms of cardiac disease in pregnancy are nausea, fatigue, severe shortness of breath, swelling of the lower body, excessive urination during the night, etc.

Factors That Can Increase The Risk of Developing Heart Diseases During Pregnancy

The physiological changes during pregnancy are highly pronounced in the cardiovascular system of the human body. Congenital heart diseases, i.e., ones since birth, make pregnancy difficult. If the birth of the baby is pre-planned, mothers with such heart diseases should consult the doctors before getting pregnant. 

Specialists should be consulted in cases of unplanned pregnancy. Cardiomyopathy, i.e., the inefficiency of heart muscles to pump extra blood, and valve issues are other pre-existing factors that can endanger the baby and the mother during pregnancy.

Besides these, other high-risk factors that can affect heart diseases during pregnancy are:

  1. Women more than the age of 30 have multiple pregnancies or have a history of complicated pregnancies. 
  2. Consistent alcohol and drug abuse
  3. Obesity with a 30+ BMI
  4. High blood pressure
  5. Poor nutrition

Treatment for Heart Disease During Pregnancy

Depending on the adversity of the disease, there are multiple ways to treat cardiovascular diseases during pregnancy. Something as simple as lifestyle changes can help patients with better recovery. 

The specific treatment for heart disease during pregnancy will depend on the specific type and severity of the condition. In general, the treatment approach will aim to manage symptoms, prevent complications, and ensure the well-being of both the mother and the baby.

Some of the different treatment options for heart disease during pregnancy include:

Lifestyle Changes

Lifestyle changes such has shown to be effective in treating heart disease in pregnancy, as these changes can help reduce the risk of complications during pregnancy and improve overall cardiovascular health. 

Here are some lifestyle changes that can be a treatment for heart disease during pregnancy:

  1. Eating a heart-healthy diet low in saturated and trans fats, cholesterol, and salt and high in fruits, vegetables, whole grains, and lean protein sources.
  2. Maintaining a healthy weight through healthy eating and regular exercise.
  3. Getting regular exercise, such as walking, swimming, or prenatal yoga, is recommended by a healthcare provider.
  4. Avoid tobacco, secondhand smoke, and other harmful substances such as alcohol and illegal drugs.
  5. Managing stress through relaxation techniques such as meditation, deep breathing, or prenatal massage.
  6. Monitoring blood pressure and blood sugar levels as recommended by a healthcare provider.
  7. Avoiding certain medications or substances that may be harmful to the developing foetus, as recommended by a healthcare provider.
  8. Getting adequate rest and sleep to support overall health and well-being.

Medications

Medications may be used to control blood pressure, reduce swelling, or prevent blood clots, depending on the specific type and severity of the heart condition. However, not all medications are safe to use during pregnancy, so it's important to discuss the risks and benefits of any medication with a healthcare provider.

Procedures

In some cases, procedures such as cardiac catheterisation or open-heart surgery may be necessary to repair or treat heart problems. Some common procedures that can be a treatment for heart disease during pregnancy include:

  1. Cardiac Catheterisation: This is a minimally invasive procedure that can be used to diagnose and treat certain heart conditions. During cardiac catheterisation, a thin tube is inserted into a blood vessel in the arm or leg and guided to the heart.
    The healthcare provider can use this tube to perform diagnostic tests or treat certain heart conditions, such as opening blocked arteries.
  2. Open-heart Surgery: In some cases, open-heart surgery may be necessary to repair or replace a heart valve, correct a congenital heart defect, or treat other serious heart conditions. This is a major surgery that is typically performed under general anaesthesia.
  3. Pacemaker or Defibrillator Implantation: If a woman has a heart rhythm disorder, a pacemaker or defibrillator may be implanted to help regulate the heart's rhythm. This is a minor surgical procedure that involves implanting a small device under the skin.
  4. Balloon valvuloplasty: This is a minimally invasive procedure that can be used to treat certain heart valve conditions. During a balloon valvuloplasty, a catheter with a balloon at the end is inserted into a blood vessel and guided to the heart.
    The balloon is then inflated to widen the valve opening and improve blood flow.

Monitoring

Women with heart disease during pregnancy will require close monitoring by a team of healthcare providers, including an obstetrician, cardiologist, and other specialists, as needed.

This monitoring may involve regular ultrasounds to check the baby's growth and well-being, as well as frequent appointments to check the mother's heart function and overall health.

Delivery Options

The method of delivery may also be influenced by the woman's heart condition, with some women with severe heart disease requiring a planned c-section to reduce the risk of complications during delivery.

The delivery timing may also be needed to be carefully planned to ensure the best possible outcome for both the mother and the baby.

Postpartum Care

Women with heart disease will require ongoing postpartum care to ensure that any complications are identified and managed promptly. This may involve additional monitoring of the mother's heart function and overall health, as well as monitoring of the baby's health and development.

Women with heart disease need to continue to work closely with their healthcare providers after delivery to ensure the best possible outcomes.

It’s important for women with heart disease who are pregnant or planning to become pregnant to work closely with a team of healthcare providers, including an obstetrician, cardiologist, and other specialists as needed, to ensure the best possible outcome for both themselves and their babies.

When to Consult a Doctor?

It is crucial to seek medical attention promptly if a woman has a pre-existing heart condition or experiences heart problems during pregnancy. Symptoms of heart issues during pregnancy may include chest pain, difficulty breathing, fainting or dizziness, irregular or rapid heartbeat, or swelling in the legs, feet, or ankles. 

These symptoms could indicate severe complications like heart failure and must be evaluated by a healthcare provider immediately. Women with existing heart conditions must also consult a doctor before attempting to conceive to ensure their heart condition is stable and to take necessary precautions for a safe pregnancy.

Takeaway

In conclusion, it is evident that heart diseases in pregnancy have different forms and effects. Some people may not experience extreme challenges during pregnancy, while others may be at a death risk. 

First-time mothers should be extra cautious about their pregnancy because this phase is fairly new to them, and everybody has a different response to it. But this doesn’t mean that people giving birth for the second or third time should not bother at all. One must pay regular visits to the doctor to ensure a safe pregnancy. 

We at HexaHealth are here to help you get top-notch medical assistance during your pregnancy. Our team of dedicated experts put their years of experience into action and strive to keep both the mother and baby safe during childbirth. You can connect with us today and start your consultation with ease.

Frequently Asked Questions

Is it normal to have heart disease in pregnancy?

While it is not common, some women may experience heart disease during pregnancy due to changes in their cardiovascular system and increased load on the heart. However, you must see a dedicated doctor in case of severe symptoms like irregular or fast heartbeat.

What is a cardiac disease in pregnancy?

Cardiac disease in pregnancy refers to any pre-existing or new onset heart condition that may complicate a woman’s pregnancy, delivery, or postpartum period. These diseases can often be life-threatening and thus should be consulted with a doctor.

What is the most common heart disease in pregnancy?

The most common heart disease in pregnancy is congenital heart disease, which affects many cases of pregnancies. Pregnant women must be careful when they witness early signs of heart disease and speak to their doctor to understand its cause.

What is the WHO classification of heart disease in pregnancy?

The WHO classification of heart disease in pregnancy is based on the severity of the condition and its impact on the mother and foetus. It categorises heart disease into four groups: 

  1. Group 1: No or minimal risk
  2. Group 2: Slight risk
  3. Group 3: Moderate risk
  4. Group 4: High risk

What is ACOG heart disease in pregnancy?

ACOG (The American College of Obstetricians and Gynecologists) provides guidelines for the management of heart disease in pregnancy, including the assessment of maternal and foetal risks, medical treatment, and delivery planning.

Define heart problems during pregnancy with the signs?

Heart problems during pregnancy can present symptoms such as shortness of breath, chest pain, palpitations, dizziness, or swelling in the legs, feet, or face. It is essential to consult with your doctor immediately as soon as you witness these signs.

What causes heart disease in pregnancy?

Heart disease in pregnancy can be caused by pre-existing conditions such as congenital heart disease or acquired heart conditions like rheumatic heart disease. Pregnancy-related conditions like preeclampsia or peripartum cardiomyopathy can also cause them.

What are the changes to your heart and blood vessels during pregnancy?

During pregnancy, the heart and blood vessels change to accommodate the increased demands of the growing foetus. These changes include an increase in blood volume and cardiac output, as well as a decrease in systemic vascular resistance.

How to avoid congenital heart disease in the next pregnancy?

To reduce the risk of congenital heart disease in the next pregnancy, it is important to identify any underlying genetic or environmental factors and address them through genetic counselling, preconception planning, and prenatal care. These can be effective in achieving a smooth delivery and ensuring safe childbirth.

How does a heart defect affect the baby?

A heart defect can affect the baby by causing inadequate blood flow and oxygen delivery to vital organs, leading to growth restriction, premature delivery, or even stillbirth. Additionally, some congenital heart defects may require surgical intervention soon after birth to correct the problem.

What pre-existing heart diseases could affect pregnancy?

Pre-existing heart diseases that could affect pregnancy include congenital heart disease, rheumatic heart disease, pulmonary hypertension, aortic stenosis, and Marfan syndrome. It is important to seek dedicated medical assistance if you already have any of these pre-existing heart diseases.

Which heart conditions are too dangerous for pregnancy?

Heart conditions that are too dangerous for pregnancy include severe pulmonary hypertension, severe aortic stenosis, severe heart failure, and severe left ventricular dysfunction.

What are the signs and symptoms of heart problems during pregnancy?

Signs and symptoms of heart problems during pregnancy may include shortness of breath, chest pain, palpitations, fatigue, lightheadedness, fainting, or swelling in the legs, feet, or face. If these conditions persist for long.

At what stage of pregnancy do heart defects occur?

Heart defects can occur during foetal development, typically during the first eight weeks of pregnancy, when the heart is forming. However, some defects may not be detected until later in pregnancy or after birth.

Do heart defects show on ultrasound?

Yes, many heart defects can be detected on ultrasound during pregnancy. A foetal echocardiogram, a specialised ultrasound of the foetal heart, can help diagnose and evaluate the severity of heart defects.

How do you manage heart disease during pregnancy?

Management of heart disease during pregnancy involves a multidisciplinary approach that includes close monitoring of maternal and foetal health, medication management, lifestyle modifications, and delivery planning.

How can I prevent heart defects during pregnancy?

Preventing heart defects during pregnancy involves maintaining good prenatal care, avoiding harmful substances, getting enough folic acid, and managing pre-existing medical conditions that could increase the risk of congenital heart defects.

Which food is good for the heart in pregnancy?

Foods that are good for the heart during pregnancy include fruits, vegetables, whole grains, lean proteins, low-fat dairy products, and healthy fats like omega-3 fatty acids from fish, nuts, and seeds. Maintaining a balanced diet is crucial for pregnant women to ensure smooth delivery.

Is heart medication safe during pregnancy?

Certain heart medications may be safe to use during pregnancy, but others may pose risks to the developing foetus. It is essential to discuss medication management with a healthcare provider.

What are the risks and complications of heart disease in pregnancy?

The risks and complications of heart disease in pregnancy can vary depending on the severity of the condition and its impact on maternal and foetal health. Some complications may include preeclampsia, premature delivery, stillbirth, foetal growth restriction, and maternal heart failure or stroke.

How to avoid congenital heart disease in next pregnancy?

There is no guaranteed way to avoid congenital heart disease in the next pregnancy, but some steps can help reduce the risk. These include preconception counselling, genetic testing, managing chronic health conditions, avoiding harmful substances, and getting appropriate prenatal care.

Consultation with a healthcare provider is recommended for personalised advice.

References

All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.


  1. Cardiac Disease In Pregnancylink
  2. Heart Disease & Pregnancylink
  3. Heart conditions and pregnancy: Know the riskslink

Updated on : 14 April 2023

Reviewer

Dr. Arti Sharma

Dr. Arti Sharma

MBBS, DNB Obstetrics and Gynaecology, Diploma In Cosmetic Gynaecology

8 Years Experience

Dr Arti Sharma is a well-known Obstetrician and Cosmetic Gynaecologist currently associated with Aesthetica Veda in Bengaluru. She has 8 years of experience in Obstetrics and Cosmetic Gynaecology and worked as an expert Obstetrician...View More

Author

Charu Shrivastava

Charu Shrivastava

BSc. Biotechnology I MDU and MSc in Medical Biochemistry (HIMSR, Jamia Hamdard)

2 Years Experience

Skilled in SEO and passionate about creating informative and engaging medical content. Her proofreading and content writing for medical websites is impressive. She creates informative and engaging content that educ...View More

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