Is Your Heart Strong Enough to Have a Baby?

If you are considering starting a family, the idea of a little human growing within your body can feel almost surreal. Many questions may come to mind — about the pregnancy, labour and delivery process, lifestyle and body changes, or future challenges that lie ahead. Many women spend time searching the internet for perinatal advice. However, it would be safer for both mother and baby if you took a more proactive approach by arranging a preconception medical screening with your doctor to identify any health risks that might lead to complications during pregnancy.

A healthy cardiovascular system is crucial for a normal pregnancy. Cardiovascular diseases occur in 1 – 4% of all pregnancies and can have serious consequences. In fact, cardiovascular disease is now the leading cause of death in pregnant women and women during the postpartum period (first 6 – 8 weeks after delivery) in many developed countries. The risk is higher in women with congenital or pre-existing heart conditions. Women having a baby at a later age or who have metabolic, including diabetes, hypertension or overweight, also have a higher risk of maternal heart disease. Pre-pregnancy heart health screening should be considered in these higher-risk groups.

How does pregnancy affect the heart?

Pregnancy increases the workload of the heart. Your heart has to pump about 30 – 50% more blood than usual, and its rate increases to meet the demands of both your body and your growing baby. It’s like being on a treadmill, running at a steady pace all day and night without stopping.

Even if your heart was healthy before pregnancy, the increased workload can still lead to heart issues in some women. Women with pre-existing heart conditions may face an even higher risk, making regular monitoring crucial to prevent complications.

In general, heart conditions associated with pregnancy include:

• Pre-existing heart disease in women with congenital or heart conditions acquired before pregnancy, such as valve disorders, arrhythmias, or previously diagnosed heart failure.
• Heart conditions that develop during pregnancy, such as peripartum cardiomyopathy (heart failure associated with pregnancy) or preeclampsia (high blood pressure and complications during pregnancy).

What are the chances of a young and healthy woman developing heart problems during pregnancy?

For women with no pre-existing heart conditions, the chances of developing cardiac disease during pregnancy are relatively low. However, pregnancy places additional strain on the heart, which can occasionally lead to complications, especially if the woman has risk factors such as high blood pressure, obesity, diabetes, or multifoetal pregnancies. Women who had gestational diabetes and hypertension are at higher risk of heart conditions during subsequent pregnancies.

Is heart disease during pregnancy more likely to affect women with pre-existing or congenital heart conditions?

Yes, women with pre-existing or congenital heart conditions are more susceptible to complications during pregnancy. Their hearts may have difficulty managing the increased workload of pregnancy, leading to complications such as arrhythmias or heart failure. It is crucial that these women work closely with specialists to ensure safe pregnancies.

Can I go through pregnancy safely if I have a heart problem?

If you have previously been diagnosed with a heart condition, it is crucial to consult both a cardiologist and an obstetrician before planning a pregnancy. Certain cardiovascular diseases, such as congenital heart disease complicated by pulmonary hypertension, existing heart valve diseases like mitral stenosis or aortic stenosis, previous mechanical heart valve implantation, heart failure, and diseases of the aorta, can pose significant risks. These conditions may lead to serious complications and poor outcomes for both mother and baby, and pregnancy may need to be avoided. However, thorough evaluation and discussion with your doctors are essential to fully understand your situation and explore any potential options.

Other heart conditions may also carry risks for mother and baby during pregnancy, but early evaluation is key. Consulting your doctors (typically a cardiologist and an obstetrician working together, and sometimes other specialists if necessary) before pregnancy enables a formal risk assessment and the creation of a personalised care plan. This care plan can involve medication adjustments, clinical surveillance during pregnancy, and a detailed planning for the labour and delivery process to ensure the best outcomes for both mother and baby.

Can my child inherit my heart condition?

Some congenital heart conditions can be inherited, though the risk varies depending on the condition. If either parent has a heart condition, heart health screening prior to pregnancy and even genetic screening are advised to understand the chances of passing it on and plan appropriate care if needed.

Foetal heart abnormalities are often detected during pregnancy scans between weeks 18 and 21. Attending all recommended scans and check-ups is essential, as early detection allows timely intervention to support the well-being of both mother and baby.

What should women with heart conditions do before or when trying to conceive?

Women with heart conditions should take the following steps prior to conception:

• Consult their doctor: Speak with both a cardiologist and an obstetrician to understand the risks and receive a personalised evaluation.
• Review medications: Some heart medications may not be safe during pregnancy and may need to be adjusted.
• Optimise heart health: Regular health check-ups and clinic reviews could optimise current heart conditions. Maintaining a well-balanced diet, managing chronic conditions, and avoiding harmful substances such as alcohol and tobacco also contribute to healthier heart health and optimise the chances of a safe pregnancy.

Are there any ways to prevent heart complications during pregnancy?

While not all complications can be avoided, the following measures can help reduce risks:

• Adopt a healthy lifestyle: Maintain a balanced diet, stay active, monitor weight gain, and avoid alcohol, smoking, and second-hand smoke. Managing stress through relaxation techniques or counselling is also important to support a healthy pregnancy.
• Go for pre-conception health screening: This allows existing medical conditions to be diagnosed prior to conception so that pregnancy risks can be assessed and fully understood.
• Monitor blood pressure and blood sugar levels: Detecting medical conditions such as preeclampsia or gestational diabetes early enables early treatment and reduces complications during pregnancy for both mother and baby.
• Attend regular antenatal check-ups: These appointments allow doctors to detect and address any emerging issues promptly.

Will developing heart conditions during pregnancy affect my baby?

In some heart conditions, complications during pregnancy can affect the baby, potentially leading to restricted growth or premature delivery. However, with early diagnosis and appropriate treatment, many women with heart conditions go on to have healthy pregnancies and deliver healthy babies.

What are the symptoms of heart problems in pregnancy to watch out for?

Some heart-related symptoms may be mistaken for common pregnancy discomforts. However, you should seek medical advice if you experience:

• Severe shortness of breath
• Persistent and recurring chest pain
• Palpitations, especially with associated symptoms
• Associated dizziness or fainting spells
• Swelling in the legs, feet, or face

Can I opt for a normal delivery if I have heart complications during pregnancy?

Yes, women with heart conditions can still have vaginal delivery with appropriate monitoring. The delivery method depends on the heart and medical conditions the mother has and also the growth and health status of the baby in utero. Your healthcare team will assess, plan and advise on the safest delivery and labour plan.

Will I be able to breastfeed my baby if I am on heart medications?

Many heart medications are compatible with breastfeeding, but some may require adjustments. Your doctor will review and adjust your medications to ensure they are safe for both you and your baby. If changes are needed, alternatives can usually be found.

Have concerns about your heart health?

Managing heart conditions during pregnancy requires careful evaluation and planning, but with the right medical support, most women can experience a healthy pregnancy and safe delivery.

Speak with a cardiologist if you are planning to conceive and have concerns about your heart health, or if you experience any symptoms of heart disease during pregnancy.

Early medical evaluation and advice ensure the best possible outcome for both you and your baby.