Heart Disease in Pregnancy

Your heart works harder during pregnancy to keep up with the demands of your growing baby. That’s why pregnancy is sometimes described as a “stress test” for your heart. It can uncover a heart problem you weren’t aware of, or make a known heart condition worse.

Some heart problems run in families, so your baby could also be affected.

dr colin walsh heart disease in pregnancy

Types of heart disease I see in pregnant women

  • Congenital cardiac problems (you were born with the condition). Usually women know they have a heart problem, or they had a surgical repair in childhood. Examples include ‘holes in the heart’ (atrial and ventricular septal defects), co-arctation of the aorta, Tetralogy of Fallot.
  • Ischaemic heart disease (angina, ‘heart attacks’). We are seeing more of this as mothers are getting older.
  • Valve problems. Valves in the heart keep the blood flowing in the right direction. Valves can become too narrow (stenosis) or stop closing all the way (regurgitation).
  • Cardiomyopathy – basically the heart muscle doesn’t pump properly. It can be due to genetic abnormalities, viruses, drugs, high blood pressure, other diseases like diabetes, and even pregnancy itself.
  • Arrhythmias – when the heart beats too fast, too slow, or is irregular. This includes women with pacemakers and automatic defibrillators.

How will a heart problem affect my pregnancy?

This is a huge topic – there are whole textbooks devoted to heart disease in pregnancy! But as a first step, these are some of the questions you and your doctors need to consider:

    • What is the condition?
    • How badly does it limit your physical activity?
    • What medications do you take? Are they safe for an unborn baby?
    • Is your baby also likely to have this heart problem?
    • Which doctors need to be on your team? It might include a cardiologist, cardio-thoracic surgeon, Maternal-Fetal Medicine specialist, obstetric physician, anaesthetist, geneticist…
    • Do you need special tests before or during pregnancy?
    • Is the extra strain of pregnancy likely to cause you harm?
    • Is pregnancy safe at all? There are a handful of conditions where pregnancy is simply considered too dangerous.
    • What is the safest way to give birth – vaginal birth or caesarean?
    • Is your local hospital ok for the birth, or do you need to be referred to a major hospital?

Pre-pregnancy counselling

If you have a heart problem and are considering pregnancy, then pre-pregnancy counselling is absolutely essential. You need to clearly understand your level of risk. You may also need special tests or a change in your medications before you conceive. It gives you time to assemble the right team of doctors and work out a roadmap for ongoing care.

As always, this information is intended for general educational purposes only. It is not medical advice. Please discuss any medical issues with your own doctor. Read our full medical disclaimer here.