Young women with heart conditions are often concerned about whether they can have a healthy pregnancy. When her patients raise these concerns, Chileshe Nkonde-Price, MD, director of the
Women’s Cardiovascular Program, reassures them that pregnancy is possible and safe—as long as they work with their doctors to manage their heart condition before, during and after pregnancy.
Managing Acquired Heart Disease
“There are actually two different populations of women with heart conditions: women who have conditions they were born with (congenital heart disease), and those with conditions that have
developed during adulthood (acquired heart disease),” says Nkonde-Price. “We are finding that the risk of cardiac complications is not as high as expected in women with congenital heart disease. In fact, recent studies have shown that these women do well at the time of delivery. However, less is known about women with acquired heart disease.”
“The population of women who are becoming pregnant is changing as birth rates for women in their 30s, 40s and 50s steadily rise. It is not uncommon for women to now begin a pregnancy with acquired cardiac conditions."
These conditions include high blood pressure, heart failure, coronary heart disease (heart attacks), heart valve disease and heart rhythm disorders (arrhythmias). Nkonde-Price has a few pieces of advice for women who become pregnant while managing any of these conditions:
- Talk to your doctor right away – ideally before you become pregnant – about your health and the medications that you’re taking for your cardiac conditions, as some medications could harm the developing baby.
- Be cared for in an environment where you have access to a team of multidisciplinary physicians that would include, at a minimum, an Ob/Gyn and a cardiologist.
- Establish prenatal care early in pregnancy and keep all of your prenatal appointments.
- Don’t be afraid to ask questions. Symptoms of pregnancy and symptoms of heart disease are often similar. Women should feel comfortable approaching their cardiologists with questions or for evaluation as often as needed. “It’s better to be inconvenienced and sent home than risk harm to themselves or baby,” says Nkonde-Price.
- Learn if you are at risk for passing on your condition to your child.
- For women who start a pregnancy with high blood pressure, know that your blood pressure is allowed to be a little higher—but not too high—during pregnancy. Work with your doctor to understand what blood pressure range is right for you at each stage of your pregnancy. You may need to switch or even hold off on medication for hypertension during your pregnancy.
Preeclampsia: An early indicator of heart disease
Preeclampsia is an issue for five to nine percent of women during pregnancy. This condition affects numerous systems in the body, including the heart, and can be dangerous for both the mother and baby.
“We don’t yet know how to predict who will get preeclampsia,” Nkonde-Price says. “It’s important to go to all of your prenatal appointments so your doctor can monitor your blood pressure, protein in the urine, and other symptoms.”
Symptoms that may point to preeclampsia include headache, blurred vision, nausea, and pain under the ribcage on the right side.
Because women with preeclampsia are four times more likely to develop high blood pressure within 10 years of their delivery and twice as likely to have a heart attack, Nkonde-Price advises her patients to adopt a heart-healthy lifestyle after pregnancy that may help prevent cardiac issues down the road.
“We used to think that delivering the baby was the cure, but now we know that preeclampsia is a condition in which delivery is the first treatment,” she says. “Women are typically in early adulthood and don’t have other cardiac risk factors when they have a pregnancy complicated by preeclampsia. For some women, preeclampsia is the only indicator that they are at higher risk for heart disease during their lifetime. I tell my patients that it’s important to use your lifestyle as your medicine.”
As far as the risk associated with future pregnancies, Nkonde-Price reassures her patients with preeclampsia that they can certainly have another child, but preeclampsia may occur in a subsequent pregnancy.
“If preeclampsia develops at term the risk of recurrence is 15 to 18%,” she says. “If you develop preeclampsia prior to 37 weeks however, the risk of recurrence is higher –25 to 40%. Overall,
preeclampsia is more common in first pregnancies and more often occurs at term.”
Delivering with Heart Disease
Cardiac conditions rarely dictate whether a woman delivers vaginally or gives birth via a cesarean section. In fact, Nkonde-Price says that most women can opt for vaginal delivery if they want, even if they have heart disease.
“The decision to deliver via C-section is usually the result of an obstetric issue,” she says. “That’s why this determination is always made by the Ob-Gyn in consultation with the cardiologist and anesthesiologist as a woman nears the end of her pregnancy.”
The bottom line is that when your care is coordinated by a multidisciplinary team – that cares for you before, during and after your pregnancy – you can have a healthy pregnancy even with a cardiac condition.