Pregnancy places an increased demand on a woman’s heart. Therefore, women with existing heart disease require special care during pregnancy and delivery to prevent complications.

Heart-related conditions may also develop in otherwise healthy women who become pregnant. These gestational heart-related problems include peripartum cardiomyopathy, pregnancy-induced hypertension, preeclampsia, blood clots and others.

Congenital heart disease could also develop in the fetus. Congenital heart diseases include abnormalities with the structure of the heart, including the valves and chambers, and problems with the vessels that carry blood to and from the heart.

Women who are pregnant, or are planning on becoming pregnant in the near future, are encouraged to work closely with their physicians to determine which diagnostic tests or preventive measures (e.g., medication, bed rest) may be the most appropriate for them and for their developing baby. Women with heart disease or other heart conditions are encouraged to discuss pregnancy with their physicians before deciding to become pregnant.

Pregnant heart patients need special care during pregnancy and delivery to avoid a pregnancy complication. Because pregnancy places an increased demand on the expectant mother’s heart, a woman with existing heart disease is at increased risk for heart problems. This is why women with heart disease or other heart conditions are encouraged to discuss pregnancy with their physicians before deciding to become pregnant.

Some heart-related conditions carry greater dangers for the mother and/or the child than others. Studies show that good prenatal care, which includes close physician participation throughout the pregnancy, increases the chances of a healthy baby and mother. 

Heart-related conditions may also develop in otherwise healthy women who become pregnant. These gestational heart-related problems include:

• Peripartum cardiomyopathy. A rare type of dilated cardiomyopathy that is due to complications from pregnancy. One of several gestational heart-related conditions, it most often occurs in women over the age of 30 during the last three months of their pregnancy or within four to six months after delivery. It is also more common among women who have had multiple children, are carrying twins (multiple birth) or who have preeclampsia (see below). Peripartum cardiomyopathy can be a serious or even life-threatening risk for the mother and can also put her unborn child at risk. In some women, heart function does not return to normal after pregnancy.
  
  
• Pregnancy-induced hypertension (high blood pressure). High blood pressure during pregnancy can affect the supply of oxygen to both mother and fetus. This can, in turn, increase the risk of stroke and seizures in the mother and delayed physical development in the fetus. Smoking, being overweight, having diabetes and having a family history of high blood pressure are some risk factors for pregnancy-induced hypertension. A multiple birth also increases the risk. Pregnancy-induced hypertension usually clears up within six weeks of giving birth, however, more studies are needed to see if the mother is at long-term risk of developing hypertension later in life.
  
  
• Preeclampsia. This condition is closely linked to pregnancy-induced hypertension. It typically occurs after the 20^th week of pregnancy and is characterized by elevated blood pressure and protein in the mother’s urine, which is the result of kidney problems. Preeclampsia can affect the mother’s kidneys, liver and brain. It may also cause seizures. In this case, it is called eclampsia and is the second-leading cause of maternal death.
  
  
• Pregnancy-induced diabetes (gestational diabetes). A condition in which women develop type 2 diabetes during pregnancy, returning to normal after delivery. Studies have shown that one-half of those with gestational diabetes developed type 2 diabetes again within the next 15 years. These women are also more likely to have gestational diabetes with a future pregnancy.
  
  
• Strong, fast, “galloping” heart beat (palpitations). Pregnancy places a greater demand on the heart. This could result in episodes of rapid heartbeat (tachycardia) or palpitations. Generally, these are common, normal occurrences. However, women are advised to see their physicians in order to rule out serious conditions.
  
  
• Varicose veins. An increase in blood volume is a normal part of pregnancy. Along with quite obvious physical growth, these changes place a stress on the leg veins. As a result, veins in the leg can swell and bulge. The risk for developing varicose veins increases if a woman is overweight and/or has a family history of varicose veins.
  
  
• Blood clots. Blood clots are the leading cause of death in pregnant women. They may form in the superficial veins of the legs (superficial vein thrombosis) or in the deep veins of the leg (deep vein thrombosis). If a blood clot breaks free and travels through the body, it can clog another vessel. If this happens in the lungs it is called a pulmonary embolism. If this happens in the brain, it is called a stroke. Women who are at risk for blood clots may be given an anticoagulant (e.g. heparin) to prevent blood clots from forming.
  
  
• Amniotic fluid embolism. A very rare type of embolism known to occur when placental membranes rupture (e.g., difficult labor, Cesarean section). Amniotic fluid travels to the lungs, where it can cause shock, tachycardia and sudden cardiac death.
  
  
• Heart murmur. An abnormal heart sound that results from the turbulent flow of blood through the heart. Most heart murmurs are harmless. In pregnant women, an increased blood flow through the heart may cause a heart murmur. However, heart murmurs may also indicate an underlying heart condition, such as a problem with the heart valve.
  
  
• Arrhythmias. An abnormal heartbeat that may be unusually fast (tachycardia) or unusually slow (bradycardia). Arrhythmias can develop during pregnancy in women with a normal heart and those with undiagnosed heart disease. In most cases treatment is not required.  

Women who develop a heart condition during pregnancy may require the care of a cardiologist for the duration of their pregnancy.

A heart defect or other congenital heart disease could also develop in the fetus. Congenital heart diseases include abnormalities with the structure of the heart, including the valves and chambers, and problems with the vessels that carry blood to and from the heart. In the vast majority of patients, the cause of congenital heart disease is unknown. However, there are some risk factors that have been associated with a higher rate of congenital heart disease. These risk factors include:

• Chromosomal or genetic abnormalities (e.g., Down syndrome) in the child
  
  
• Certain medications taken during pregnancy
  
  
• Alcohol or drug abuse during pregnancy
  
  
• Exposure to certain environmental agents (e.g., some pesticides, lead)
  
  
• Maternal viral infection, such as rubella (German measles) in the first trimester
  
  
• Maternal fever early in pregnancy or around conception
  
  
• Maternal diabetes (that is, pre-existing diabetes, and not gestational diabetes)
  
  
• Maternal obesity
  
  
• Poor nutrition (e.g., from eating disorders, unbalanced diet)

The American Heart Association estimates that about 1 out of every 100 babies is born with a congenital heart defect of some kind, and some defects appear to run in families. Potential parents who have congenital heart disease are encouraged to have genetic counseling and a prenatal/delivery team that includes a high-risk pregnancy obstetrician and an experienced cardiologist.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to pregnancy and the heart:

1. Is there any way to tell whether I have a heart condition that could affect my pregnancy?
   
   
2. Could my current heart problem interfere with my pregnancy in any way?
   
   
3. What is the best way to monitor my heart condition throughout my pregnancy?
   
   
4. Do you recommend any diagnostic tests, treatments or preventive measures to better diagnose and treat my heart condition while I am pregnant?
   
   
5. Are there any lifestyle changes I can make to increase the chances that my heart problem will not interfere with my pregnancy?
   
   
6. Could I develop a heart problem as a result of my pregnancy? How would I know if this has occurred? Could this threaten my pregnancy?
   
   
7. If my pregnancy does cause me to develop a heart condition, will this condition go away after I give birth? If so, how soon?
   
   
8. Is there any way to tell whether my unborn child has a heart problem?
   
   
9. Are there any lifestyle changes I can make to reduce the chances of my child being born with a heart problem?
   
   
10. Can treatment for my unborn child's heart problem begin before I have given birth? What type of treatment do you recommend?