Cardiac problems in pregnancy

Cardiovascular diseases are not uncommon during pregnancy; they are the leading cause of complications during pregnancy. Growing a child induces a lot of stress on the heart and circulatory system, which is why it is vital to understand the risks and options for prevention. In this article, a consultant cardiologist and obstetric physician explains the possible cardiac issues that may arise during pregnancy.

What are the signs of cardiac problems during pregnancy?

Whilst pregnant, the heart and blood vessels have to work harder in order to ensure a healthy, growing baby. Blood volume can increase by 50 per cent, and the heart rate increases by up to 20 beats per minute to pump more blood. These changes can affect the body, making women feel fatigued, dizzy, lightheaded, short of breath, and have an overly rapid heartbeat. Whilst these changes are expected during pregnancy, they can also be a cardiac concern by:

• Exacerbating pre-existing conditions – even if they were mild or managed before pregnancy
• Revealing unknown, underlying conditions
• Causing conditions to develop during pregnancy

These symptoms may indicate something is wrong with the heart if they begin or worsen after week 20 of pregnancy, they obstruct daily life and tasks, and if shortness of breath occurs during rest or whilst sleeping. Fainting, blurriness of vision, and chest pain (angina) are not normal symptoms during pregnancy.

Who is at risk of cardiac problems during pregnancy?

Due to the amount of stress inflicted on the heart, pregnancy becomes more dangerous and is not recommended for both mother and baby if the mother has:

• Class III to IV heart failure
• Heart muscle weakness from a previous pregnancy (peripartum cardiomyopathy)
• Valvular narrowing (stenosis)
• Hypertension

Additionally, congenital heart conditions, which may have never been a cause for concern, can worsen during pregnancy, such as:

• Coarctation of the aorta (where the aorta narrows)
• Abnormal aortic valves
• Eisenmenger’s syndrome (impaired blood flow in the heart and lungs)
• Marfan syndrome (issues with connective tissues between organs and muscles)

Other factors that put prospective mothers at risk of developing or worsening cardiac issues during pregnancy are being over 30 years old, diabetic, and the use of substances like tobacco, alcohol, and cocaine.

What are the cardiac complications that can arise during pregnancy?

Having a heart condition does not mean that a woman cannot safely become pregnant and carry a healthy baby to term, but there are serious risks and complications to keep in mind. Cardiovascular diseases contribute to around four per cent of pregnancy issues, and around a third of pregnancy-related deaths occur because of cardiac problems. Some such conditions include as:

• Arrhythmia, which can lead to blood clotting and thus strokes
• Valvular disease, where any scarring or dysfunction can cause the blood to flow in the wrong direction in the heart
• Heart failure (peripartum cardiomyopathy), where the heart starts to fail to pump blood effectively
• Preeclampsia, which is related to high pressure around week 20
• Gestational diabetes, where high blood sugar (hyperglycaemia) develops around week 20
• Spontaneous coronary artery dissection, where tears form in the arteries leading to the heart (this most commonly occurs after delivery)
• Myocardial ischemia, where the heart isn’t receiving enough blood

How can cardiac problems be diagnosed during pregnancy?

Expectant mothers can approach their doctors with their concerns and any unusual symptoms so that they can be investigated thoroughly with tests, exams, and scans. One such scan that may be performed is an echocardiogram, which is an ultrasound that creates an image of the heart’s structure to assess functionality.

The first signs of heart issues during pregnancy that the doctor may catch with their investigation could be:

• An enlarged heart
• A heart murmur
• Hypertension
• A specific protein in the urine
• Swollen veins in the neck or feet and legs

It is essential to attend prenatal medical appointments often so that cardiac – and other – issues can be uncovered as soon as possible.

How can cardiac problems in pregnancy be avoided and managed?

Medication (when recommended and prescribed), lifestyle alterations, and regular contact with healthcare providers will help protect mothers and their babies.

Some medications are not safe for pregnant women to take, as they can have unexpected effects on the baby. Doctors will weigh the risks with the urgency of care, and will prescribe the best possible option with a dosage customised according to the needs of the mother and baby.

A healthy diet and weight will ensure that both baby and mother are properly nourished throughout the pregnancy. Avoid excess sugar, sodium, and harmful fats, and partake in safe, non-strenuous exercise. Another aspect is to avoid stressors and emotionally disturbing things; patients can learn to meditate or implement other strategies for emotional regulation.

In some cases, patients may be recommended to undergo procedures that will assist with heart function, only if considered medically necessary – ideally, during the second trimester when preterm delivery, contractions, and miscarriage are the least likely.