Heart Health during Pregnancy

Dr. Yasmin Imdad, Senior Consultant – Obstetrics & Gynaecology, Kinder Women’s Hospital and Fertility Centre, Bengaluru

Pregnancy is a remarkable phase in the life of woman that uncovers many aspects of her health and brings about changes. An expectant mother not only bears a child within her but also overworks in order to support its survival. Her heart, in this case, plays a significant role in working harder to increase blood flow and nourish the developing baby.

But what happens when certain underlying heart problems are diagnosed during pregnancy? Is it safe to plan a pregnancy when you already have a heart problem? Here’re some highlights of things that one should know about heart problems during pregnancy and ways to ensure a safe delivery of the child.

Planning & Welcoming Pregnancy with Heart Diseases

It is a common phenomenon of discovering about our health when we undergo series of routine tests. This is inadvertently true in case of women, who find out about their health when they are pregnant or planning one. If it is not already diagnosed, underlying heart problems are discovered during this phase. If you lead an active lifestyle and follow healthy ways of living, it is better for both your baby and you. However, if you already have a diseased heart, planning a pregnancy should be an informed decision. Consult to understand the risk factors, evaluate, and determine ways to ensure that it is a safe pregnancy and stick to the instructions shared by the experts to manage this high-risk pregnancy.

Pregnancy and Heart Disease
With pregnancy, the heart and blood circulatory system face extra stress and pressure which results in increase in the blood volume by 30-50% in order to nourish the baby. The heart pumps more blood leading to increased heart rate. While it is normal for the heart rate to go up by 10-20 times per minute during pregnancy, it is not a healthy sign for the diseased heart. The cardiac output, needless to say, is also high by 30-50%.

Gestational hypertension, a condition where the blood pressure increases during pregnancy, can also increase risk factors of heart disease in an expectant mother, and must be duly managed and monitored properly.

Pre-existing heart diseases including heart valve issues, congenital heart defects and congenital heart failure increase the risk of developing complications during pregnancy.

Labor and delivery also puts extra stress on the heart, with abrupt changes that occur in the blood flow and pressure. It may take few weeks post-delivery for the heart to regain its normalcy.

Signs and symptoms to watch out for

It is crucial to identify the possible signs and symptoms that may indicate heart disease. Contact your doctor immediately if you experience:

· Difficulty in breathing

· Rapid heart rate or palpitations

· Feeling fatigued continuously

· Shortness of breath with exertion or at rest

· Angina or Chest pain

· Coughing at night or coughing with blood

Interestingly, some of these symptoms are commonly seen during pregnancy and also overlap with symptoms of heart disease too. In case there is no pre-existing heart disease, such warning signs must not be ignored. If you already have a heart disease, there are high chances of facing heart disease related complications during pregnancy depending on the type and severity of the condition. If any of these symptoms indicate heart problems, it can be diagnosed using a screening test.

Protect your heart, keep it safe

Protecting your heart during pregnancy is good for you and the baby. Any heart problem, common or serious, can be prevented and treated if the right steps are taken. This will also ensure long-term heart health too.

Similar to other disorders, taking care of your heart depends on your lifestyle, eating habits and sleep cycle. Following an active lifestyle, exercising regularly, eating heart-healthy food and maintaining a proper sleep cycle are important to ensure that your heart is safe during the magical phase of pregnancy. Routine checkups can help in ruling out potential problems as well as address the ones that can pose a risk later.

Preparing for Pregnancy
If there is an existing heart condition, the first step prior to planning a pregnancy is to talk to the cardiologist and gynecologist who will evaluate the current heart condition, manage treatment options and changes as required. Certain medications, that cannot be used during pregnancy, are substituted to avoid any risks associated with the pregnancy and fetal health.

Prenatal Visits
During prenatal visits to the doctor during the course of pregnancy, vitals including weight gain, blood pressure will be intricately monitored. You may require frequent blood and urine tests too. Your consultations with your cardiologist will depend on the severity of your heart condition and will be evaluated using diagnostic tests like Echocardiogram (to produce images of heart and its structures using sound waves) and Electrocardiogram (to check the electrical activity of the heart).

For your baby, routine checkups and specialized ultrasound tests will be done to detect any possible heart abnormalities in the fetus.

Medications
Any medication taken during pregnancy can affect fetal health. It is, therefore, important that only the safest medications are taken in the most appropriate and prescribed dosage. It is advisable not to stop the prescribed medicine or adjust dosage without consultation.

Preventing Complications
The simplest way to prevent complications if by taking care of yourself and the baby. Following these simple tips might help:

· Maintain your prenatal appointments regularly.

· Adhere to the instructions and medications prescribed and take the appropriate dosage.

· Rest as much as you can. Take frequent naps and avoid strenuous activities.

· Keep a check on your weight gain so that your baby grows safely. If you gain too much weight, it might put additional stress on the heart.

· Learn to manage your stress and anxieties. Talk to your doctor and clarify your doubts and look for ways to feel safe and at ease.

· Put a stop to everything that is harmful to you and the baby – alcohol, smoking, excessive caffeine, etc.

Will labor and delivery be painful?
Since heart problems during pregnancy is categorized under high-risk pregnancies, it is advisable to deliver the baby at a hospital that specializes in dealing with such cases. There may be certain concerns related to your heart, blood circulation or heartbeat that may require continuous monitoring, immediate care and attention.

Both your and your baby’s heart rate will be monitored alongside your contractions. In case of a C-section delivery, special precautions must be taken. Labor may be induced only under controlled situations if you have a medical history of severe cardiac disorders. If you are at risk of developing endocarditis, you may be recommended an antibiotic treatment – pre- and post-delivery.

Breastfeeding baby with heart problems
You may breastfeed your baby, even if you are on medication. Discuss all the precautions, risk of developing mastitis and necessary treatment related adjustments with your cardiologist and gynecologist to protect your baby and yourself.