DEAR DOCTOR K:
I have a heart condition. What do I need to know before I get pregnant?
When a woman is pregnant, her heart is working for two. Blood passes through her placenta to her baby. This places additional demands on her body’s circulatory system, particularly the heart. Among other changes, her heart pumps a much higher volume of blood each minute. As a woman with a heart condition, it’s particularly important for you to understand what this added workload might mean to your health, and to your baby’s.
Any woman with a heart problem should see her doctor before conceiving. If the pregnancy is unexpected, she should see her doctor as soon as she thinks she might be pregnant. The doctor can tell her if she needs to take any special precautions. The doctor may also want her to see a heart specialist (cardiologist), if she hasn’t already.
Here are some common heart conditions and how they might affect you during pregnancy:
- CONGENITAL HEART DISEASE. Most women born with an abnormality of the heart or its major blood vessels can safely have children. Before conceiving, a cardiologist should determine the type and severity of the defect. This will give you a better sense of the potential risks that pregnancy may pose.
- Babies born to women with congenital heart disease have a higher risk of having a heart abnormality themselves.
- PULMONARY HYPERTENSION. This condition causes very high blood pressure in the blood vessels of the lungs. It is associated with a high risk of dying during pregnancy.
- RHEUMATIC HEART DISEASE. In this condition, one or more heart valves do not open and close normally, obstructing blood flow. Most women with rheumatic heart disease can have a baby, but regular monitoring is needed throughout pregnancy.
- AORTIC VALVE STENOSIS. This condition also significantly elevates the risk of the mother and/or baby dying during pregnancy. It has several causes, of which rheumatic heart disease is one. Aortic valve stenosis (stiffness) reduces the amount of blood that the heart can pump out to the body. If the blockage is severe, it can cause serious problems for mother and baby. If treatment is needed, sooner is better.
- MITRAL VALVE STENOSIS. In this condition, another of the heart’s four valves becomes stiff. As a result, blood tends to back up into the lungs. Unless this condition is very mild, treatment often is needed to protect mother and baby.
- OTHER CONDITIONS. Some forms of arrhythmia (an irregular heartbeat) and cardiomyopathy (disease of the heart muscle) also increase risk of problems during pregnancy.
Finally, some heart medicines are dangerous to a developing baby. Be sure to discuss your medications with your doctor before becoming pregnant.
Most women with heart problems can have a successful pregnancy and a healthy baby. The most important thing is that you consult with your doctor about whether it is safe for you to become pregnant. If so, find out what treatments might be needed to protect both of you.