Heart Disease & Pregnancy

What is cardiac disease in pregnancy?

Cardiac (heart) disease in pregnancy refers to problems with your heart that occur while you’re pregnant. There are two main types of heart problems you could experience during pregnancy:

• Preexisting heart conditions: These are cardiovascular diseases that you had before becoming pregnant. These conditions might’ve caused no symptoms or major concerns before. But during pregnancy, they can affect you differently and lead to complications.
• Heart conditions that develop during pregnancy: These are conditions that you didn’t have before pregnancy. Some are harmless, but others can be dangerous.

Most people with a heart condition can safely become pregnant and have a healthy baby. But cardiovascular disease during pregnancy sometimes leads to serious complications. In fact, it’s the leading cause of death among pregnant people in the U.S. Here are some other key stats:

• About 1 in 3 pregnancy-related deaths in the U.S. are due to cardiovascular problems.
• Cardiovascular disease complicates up to 4 in 100 pregnancies.
• People who are Black have a much higher risk of dying during pregnancy or soon afterward. Their risk is tripled compared with people who are Hispanic or white.
• Risk factors for pregnancy-related death include having high blood pressure, obesity and being over age 40.

If you’re pregnant or planning a pregnancy, it’s important to learn how heart disease could affect you. But first, it’s helpful to take a step back and learn how pregnancy affects your heart and blood vessels.

Changes to your heart and blood vessels during pregnancy

Your body experiences many changes during pregnancy. These changes put extra stress on your body and force your heart to work harder. The following changes are normal during pregnancy. They help your growing fetus receive enough oxygen and nutrients.

• Increase in blood volume: Your blood volume goes up during the first few weeks of pregnancy and continues rising from there. Most people experience a 40% to 45% total increase in blood volume during pregnancy.
• Increase in heart rate: It’s normal for your heart rate to increase by 10 to 20 beats per minute during pregnancy. It goes up gradually during your pregnancy and is the highest by your third trimester.
• Increase in cardiac output: Cardiac output is the amount of blood your heart pumps each minute. By 28 to 34 weeks, your cardiac output may increase by 30% to 50%. This is because of the higher blood volume and faster heart rate. If you’re pregnant with twins, your cardiac output may increase up to 60%.

These changes may cause you to feel:

• Extremely tired (fatigue).
• Dizzy or lightheaded.
• Short of breath (dyspnea).
• Palpitations (sensation of a fast heartbeat).

These symptoms are a normal part of pregnancy. But here’s the tricky part: They also overlap with some symptoms of heart disease. So, you might have heart disease warning signs but think nothing’s wrong. That’s why heart disease during pregnancy can be dangerous. It can be hard to tell whether a symptom is normal or cause for concern.

If you have preexisting heart disease, you may face a higher risk of heart-related complications during pregnancy. Your risk depends on the specific condition you have and its severity.

What preexisting heart diseases could affect pregnancy?

Some heart conditions can raise your risk of pregnancy complications. If you have any of the conditions below, talk with your provider about the risks of becoming pregnant.

Congenital heart disease

Congenital heart disease is the most common form of cardiovascular disease during pregnancy in the U.S.

Congenital heart diseases are heart conditions you’re born with. They range from mild to very serious. Usually, babies with serious conditions receive treatment at a young age. But sometimes people can still experience changes in heart function after treatment or surgery.

So, if you have congenital heart disease, talk with your provider before becoming pregnant. Your provider may refer you to an adult congenital heart disease specialist or a cardio-obstetrics specialist. They will evaluate your pregnancy risks. A specialist can also help identify and manage risks for an unplanned pregnancy.

The most common heart-related complications among pregnant people with congenital heart disease are:

• Abnormal heartbeat (arrhythmia).
• Heart failure.

People with congenital heart disease also face a higher risk of premature birth.

In general, people with the following congenital heart conditions have a low risk of problems during pregnancy:

• Mild pulmonary valve stenosis.
• Small or successfully repaired “hole in the heart.” These include atrial septal defects (ASDs) and ventricular septal defects (VSDs).
• Small or successfully repaired patent ductus arteriosus (PDA).

People with these congenital heart conditions may face a higher risk of pregnancy complications:

• Aortic valve stenosis with a bicuspid aortic valve.
• Coarctation of the aorta.
• Ebstein’s anomaly.
• Fontan physiology.
• Severe pulmonary valve stenosis.
• Tetralogy of Fallot (repaired).
• Transposition of the great arteries (repaired).

There are many other congenital heart defects not on the list above. If your heart problem isn’t listed here, it’s still important to speak with your provider if you’re considering pregnancy.

Cardiomyopathy

Cardiomyopathy is the leading cause of serious complications and death during pregnancy. Your risk of complications with cardiomyopathy depends on the type you have and its severity.

Up to 4 in 10 pregnant people with dilated cardiomyopathy experience heart failure or another complication. Hypertrophic cardiomyopathy is less dangerous during pregnancy. But it may lead to complications, especially if you had symptoms before pregnancy.

If you have any form of cardiomyopathy, talk with your provider before becoming pregnant to learn your risks.

Heart valve disease

There are many forms of heart valve disease that can develop during your life. And they can range from mild to severe. Some forms of valve disease won’t affect your pregnancy, while others may raise your risk of complications. If you have a history of valve disease, talk with your healthcare provider to learn if pregnancy is safe for you.

• Aortic valve regurgitation: Your level of risk depends on the severity of the regurgitation (leakiness). If you don’t have symptoms and your heart is functioning normally, you face a low risk of complications. But if you have severe regurgitation with reduced heart function, you face higher risks and may need to avoid pregnancy. Associated conditions like Marfan syndrome or a bicuspid aortic valve may affect your risk, too.
• Mitral valve prolapse: This common condition usually doesn’t cause symptoms or need treatment. Most people with mitral valve prolapse and no other heart problems have no pregnancy complications. If your condition has led to severe valve leakiness, you may need treatment before you become pregnant.
• Mitral valve regurgitation: Your level of risk depends on how leaky your valve is, how well your heart can pump blood and whether you have symptoms. If your regurgitation is severe and you have symptoms, you may need mitral valve repair before pregnancy. People with severe regurgitation and reduced heart function may need to avoid pregnancy.
• Mitral valve stenosis: Around the world, this is the most common heart-related complication. It’s more common in areas where many people develop rheumatic fever from untreated scarlet fever and strep throat. If you have mitral valve stenosis, you may need a procedure or surgery before becoming pregnant to lower your risk of complications.

Valve replacement helps many people with valve disease live longer, healthier lives. But people with a prosthetic (artificial) heart valve need special care during pregnancy. This is because:

• Pregnancy raises your risk of blood clots. Having an artificial valve also raises your risk of blood clots.
• People with certain artificial valves need to take lifelong anticoagulant medication to lower their risk of blood clots. Some anticoagulants can be harmful to a fetus.

If you have an artificial valve, it’s very important to see a cardiologist before planning a pregnancy. Your cardiologist will talk with you about:

• Your pregnancy risks.
• The best anticoagulant therapy for you.
• Precautions you should take to prevent endocarditis.

Aortic disease

Aortic disease, also called aortopathy, refers to a group of conditions that affect your aorta. Genetic syndromes are linked with some aortic diseases.

Aortic disease raises your risk of serious complications during pregnancy. That’s because the pressure in your aorta goes up during pregnancy, especially during labor and delivery. This extra pressure increases your risk of an aortic dissection or aneurysm rupture, which can be fatal.

People with the following conditions face an increased risk of complications during pregnancy:

• Bicuspid aortic valve with aortic dilation.
• History of aortic dissection.
• Loeys-Dietz syndrome.
• Marfan syndrome.
• Turner syndrome.
• Vascular Ehlers-Danlos syndrome.

Nearly half of all aortic dissections and ruptures in women and people assigned female at birth (AFAB) under age 40 are pregnancy-related. They usually occur in the third trimester or postpartum period.

If you have aortic disease, it’s very important to see a cardiologist for an evaluation before planning a pregnancy.

What heart problems could develop during pregnancy?

Pregnancy can lead to many different problems with your heart or blood vessels. This is true even if you have no prior history of cardiovascular disease.

High blood pressure (hypertension)

High blood pressure during pregnancy affects up to 1 in 10 pregnant people. And it’s becoming more common. The increase is sharper among people who are Black compared with those who are white.

High blood pressure diagnoses include:

• Gestational hypertension: High blood pressure (of at least 140/90 mmHG) that begins after week 20 of pregnancy.
• Preeclampsia: High blood pressure that begins after week 20. It occurs along with protein in your urine (pee) or evidence of organ damage. Eclampsia refers to preeclampsia that occurs along with seizures during pregnancy or within 10 days of giving birth.
• Chronic hypertension: High blood pressure that begins before week 20 or before you become pregnant.
• Chronic hypertension with superimposed preeclampsia: Chronic hypertension along with protein in your urine or evidence of organ damage.

Gestational diabetes

Gestational diabetes is high blood sugar that develops after week 20 of pregnancy. This condition affects about 6 in 100 pregnancies in the U.S. It can occur in people of all ethnic backgrounds. But it’s most common among those who are non-Hispanic Asian.

Without treatment, gestational diabetes raises the risk of complications for you and your baby.

Arrhythmias

Pregnancy raises your risk of having an irregular heartbeat (arrhythmia) whether or not you had one in the past. Types of arrhythmias you may experience during pregnancy include:

• Ectopic heartbeat: This is an extra heartbeat that’s usually harmless.
• Supraventricular tachycardia (SVT): This is a fast heartbeat that begins in your heart’s upper chambers (atria). It’s the most common sustained arrhythmia during pregnancy (meaning it lasts longer than 30 seconds). It usually affects people who have a prior history of SVT or who have congenital heart disease. But it may also happen to you for the first time during pregnancy.

Some arrhythmias require treatment, while others don’t. People who have arrhythmias along with congenital heart disease are more likely to need treatment. Your healthcare provider will determine the safest treatment method for you.

Spontaneous coronary artery dissection (SCAD)

Spontaneous coronary artery dissection (SCAD) is a life-threatening condition. SCAD describes a tear in one or more of the arteries supplying blood to your heart. About 4 in 5 people who experience SCAD were assigned female at birth. About 1 in 3 cases are pregnancy-related. SCAD usually occurs within one week of giving birth, but it may occur in late pregnancy or within six weeks of delivery.

Researchers believe hormonal changes that occur during pregnancy may play a role. Other risk factors among pregnant people include:

• Being over age 30.
• Cocaine use.
• Connective tissue diseases.
• Diabetes.
• High blood pressure.
• Tobacco use.

Myocardial ischemia

Myocardial ischemia means your heart isn’t receiving enough blood. It can lead to:

• Stable angina.
• Unstable angina.
• Heart attack.

About 2 out of every 25,000 pregnancy-related hospitalizations are for myocardial ischemia. Risk factors for pregnant people include:

• Being non-Hispanic Black.
• Being over age 30.
• Diabetes.
• Family history of cardiovascular disease.
• High blood pressure.
• High cholesterol or high triglycerides.
• History of spontaneous coronary artery dissection (SCAD).
• Overweight/obesity.
• Tobacco use.

Peripartum cardiomyopathy

Peripartum cardiomyopathy is a form of heart failure that happens late in pregnancy or soon after giving birth. It affects people who don’t have a previous heart disease diagnosis. This condition prevents your heart from pumping enough blood to your body. It can occur at any age but usually affects individuals over age 30.

Peripartum cardiomyopathy affects 1,000 to 1,300 pregnant people in the U.S. each year. People who are Black have an increased risk, and they’re often diagnosed at younger ages compared with people who are white.

Deep vein thrombosis and pulmonary embolism

Pregnancy raises your risk of deep vein thrombosis (DVT) and pulmonary embolisms. These conditions are four to five times more common among pregnant people than non-pregnant people. The typical timing is within the postpartum period (within six months of giving birth).

DVT is a blood clot in a vein deep your body (usually your leg). A pulmonary embolism (PE) is a blood clot that forms somewhere in your body and travels to your lungs.

Your risk is greater if you have a prior history of blood clots or embolisms. If you have DVT or a PE, you will likely need treatment with a blood thinner. Your provider should prescribe you a blood thinner that’s safe in pregnancy.

What is the most common heart disease in pregnancy?

Congenital heart disease is the most common form in the U.S. and other developed countries.

In developing countries, rheumatic heart disease is the most common form. It accounts for about 7 in 10 cases of cardiovascular disease in pregnancy.

Which heart conditions are too dangerous for pregnancy?

Some heart conditions and related syndromes make pregnancy very dangerous. You may need to avoid pregnancy if you have:

• Aortic valve stenosis (if severe and causing symptoms).
• Coarctation of the aorta (if uncorrected or existing along with an aortic aneurysm).
• Eisenmenger syndrome.
• Fontan physiology.
• Marfan syndrome.
• Mitral valve stenosis (if severe).
• Peripartum cardiomyopathy in a previous pregnancy (with remaining damage to heart function).
• Pulmonary hypertension.
• Severe aortic dilation (at least 45 millimeters if you have Marfan syndrome, or at least 50 millimeters if you have a bicuspid aortic valve).
• Ventricular dysfunction with left ventricular ejection fraction less than 40%.

Talk with your provider if you have any of these conditions. Your provider will evaluate the severity of your condition and discuss your risks with you.

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

Some symptoms of heart problems are similar to how you’d normally feel during pregnancy. These include:

• Feeling very tired (fatigue).
• Needing to pee often.
• Shortness of breath.
• Swelling (edema) in your feet and ankles.

These symptoms may be harmless. But they could signal a heart problem if:

• They begin after week 20 of pregnancy.
• They prevent you from doing your normal daily tasks.
• You feel shortness of breath even while resting.
• You have shortness of breath that wakes you up in the middle of the night.

Symptoms that aren’t normal during pregnancy include:

• Blurred vision.
• Chest pain (angina).
• Heart palpitations that last longer than 30 seconds.
• Fainting (syncope).
• Racing heart rate (tachycardia).

Important: If you have any chest pain or discomfort, call 911 or your local emergency number right away.

Tell your provider about any and all symptoms you experience. It may help to keep a log of your symptoms. Include:

• Each symptom you feel.
• Date and time.
• Severity on a scale of 1 to 10 (with 10 being most severe).
• What you’re doing at the time (for example, exercising, doing light housework or resting).

Symptoms are feelings or changes that you experience. Signs are red flags your healthcare provider notices through a physical exam or testing. Signs of heart problems during pregnancy include:

• Enlarged heart (cardiomegaly).
• Heart murmur.
• High blood pressure.
• Protein in your urine (pee).
• Swollen veins in your neck (jugular venous distention).

Your provider will check you for signs of heart problems during your prenatal appointments.

How do you manage heart disease during pregnancy?

Medical care and self-care can help you manage heart disease during pregnancy. Here are some tips:

• Attend your medical appointments. You’ll likely receive care from an obstetrician and a cardiologist. Be sure to keep all your appointments and follow-ups. You may need regular testing (including echocardiograms) to check your heart function.
• Avoid excess weight gain. Ask your provider how much weight is safe for you to gain during pregnancy.
• Avoid stress. As much as possible, avoid situations that cause you emotional upset. Also, find relaxation strategies that make you feel calm. Prenatal yoga classes may be helpful if your provider says they’re OK for you.
• Eat a heart-healthy diet. Follow your provider’s guidance on foods to eat and foods to avoid. In general, try to limit your intake of sodium, sugar, saturated fat and trans fat.
• Exercise safely. Your provider will tell you how often to exercise and which types of exercise are safe for you. Be sure to follow their guidance closely. You may need to avoid activities that put too much strain on your heart.

Depending on your condition, your provider may recommend a procedure to help your heart function better. Usually, it’s best to have such procedures before becoming pregnant. Your medical care team will evaluate your situation and decide the best path forward.

You may also need medications to manage certain conditions or risk factors. Talk with your provider about which medications are safe for you to take during pregnancy and which ones are unsafe.

Cardiovascular disease medications during pregnancy

Part of your management plan includes taking your medications as prescribed. Your provider may make changes to your medications. This is because some heart disease medications aren’t safe to take during pregnancy.

Unsafe medications include:

• ACE inhibitors.
• Angiotensin receptor blockers (ARBs).
• Aldosterone antagonists.
• Some anticoagulant medications, like warfarin.
• Some medications that treat pulmonary hypertension, like riociguat and bosentan.

Important: If you are taking any of these medications and become pregnant, contact your healthcare provider right away. Don't stop taking any medication without talking to your provider first.

Postpartum monitoring

Some complications can happen within six months of giving birth. Your medical care team will monitor you and check your heart function. It’s essential to keep all your appointments even though you'll be very busy and tired during this time. Your care team will also talk with you about the safety and risks of planning future pregnancies.

Will heart problems during pregnancy affect me later in life?

Heart problems during pregnancy raise your risk of cardiovascular disease later in life. Here are some key numbers:

• Gestational diabetes raises your risk of cardiovascular disease later in life by 68%.
• High blood pressure during pregnancy raises your risk of cardiovascular disease by 67%.
• Preeclampsia makes you 75% more likely to die of cardiovascular disease later in life.

These numbers may be startling. But the good news is that numbers only tell part of the story. They also reflect situations from the past. And they don’t have to predict your future. Use this knowledge to plan strategies for reducing your cardiovascular disease risk. If you have one of these conditions during or within a few months of your pregnancy, talk to your provider after you give birth and ask to be screened for cardiovascular disease.

There’s a lot you can do to prevent cardiovascular disease or slow down its progression. You may need long-term follow-ups with a cardiologist to check your heart health and catch any early signs of problems. Talk with your care team about lifestyle changes that’ll help make your heart and blood vessels healthier for years to come.

A note from Cleveland Clinic

If you have heart disease and are planning a pregnancy, now is the time to talk with your healthcare provider. Learn your risks and how you can manage your heart condition while pregnant. If you experience an unplanned pregnancy, it’s also very important to talk with your provider right away. Your provider will evaluate your risk for complications. They may also change your heart disease medications to make them safer for pregnancy.

If you don’t have heart disease, it’s still important to learn how unexpected heart issues can affect pregnancy. Talk with your provider about your risk factors. Work with your provider to lower your risk so you can have a safe and healthy pregnancy.