What to Know About Heart Disease and Pregnancy

Heart disease can be a condition that a person has from birth (congenital) or one that develops later in life (acquired).

Heart disease during pregnancy refers to several types of problems that affect your heart, such as conditions like cardiac arrhythmias, high blood pressure, heart failure, coronary artery disease, valve disorders, and congenital heart defects.

There are also some changes to the heart and circulatory system that are normal when a person is pregnant. That said, heart disease patients need to have close monitoring by their healthcare team during pregnancy to avoid complications.

Here’s what you need to know about heart disease and fertility, pregnancy, childbirth, and the postpartum period.

Heart Disease and Fertility

Research has shown a possible link between infertility and developing heart disease. If you have concerns about your fertility and heart disease, share them with your healthcare provider before you try to conceive.

Treatments are available that may improve fertility, including lifestyle changes, medications, hormonal treatments, and assisted reproductive procedures.

If you don’t regularly see a cardiologist (a doctor who specializes in heart disease), your primary healthcare provider may refer you to one if they cannot answer your specific heart disease-related fertility questions.

Heart Disease and Gestation

People with some forms of heart disease—such as heart valve disorders or congenital heart defects—can often have successful pregnancies. Moderate or severe heart conditions may increase the risk of complications during pregnancy, labor, delivery, and postpartum.

During pregnancy, the body undergoes many changes to the circulatory system that put stress on the heart. Some of these changes include:

• Blood volume increase by 40% to 50%
• Increase in the amount of blood the heart pumps per minute
• Heart rate increase by 10 to 15 beats
• Blood pressure decrease

Pregnant people with heart disease may experience a worsening of their condition, or experience pregnancy symptoms like fatigue, shortness of breath, and lightheadedness more severely.

It’s essential to discuss risks and possible pregnancy scenarios with your healthcare team, which should include a cardiologist and potentially a neonatologist (a pediatrician who specializes in the care of newborns).

Your team will evaluate different aspects of your care throughout your pregnancy, including:

• How well you are managing your heart condition
• If medications need to be stopped, started, or adjusted
• The need for any additional surgical interventions, treatment, or additional monitoring for you or the fetus
• The risk to the fetus of inheriting a heart defect
• A careful plan for delivery specific to your condition

Risks

Pregnancy requires the heart to pump harder, which means that it has the potential to worsen a heart condition or even cause an underlying heart condition to produce noticeable symptoms for the first time. Complications such as fluid in the lungs (pulmonary edema), abnormal heart rhythm, or even stroke can also occur.

Risks during pregnancy will depend on the type and severity of the heart disease.

• Minor heart conditions such as heart arrhythmia can be treated with medication if necessary.
• Serious heart conditions such as an artificial heart valve carry an increased risk of developing a potentially life-threatening infection of the heart’s lining (endocarditis).
• Congenital heart defects may increase the risk of premature birth and the fetus developing a similar heart defect.
• Congestive heart failure can worsen as blood volume increases during pregnancy.

Treatment

Depending on the specific heart condition and its severity, treatment options for pregnant people might include:

• Routine heart function testing with an electrocardiogram or echocardiogram
• Medication treatment (such as blood thinners) for heart conditions like valvular heart disease
• Regular exercise
• Healthy diet
• Smoking cessation

Concerning Symptoms

Symptoms of pregnancy can look like the symptoms of certain types of heart disease. Your healthcare provider can explain normal vs. abnormal symptoms and make sure that you know what to keep an eye out for.

If you notice a change in heart disease-related symptoms that you had before you were pregnant, or if you notice any new symptoms, you will want to let your healthcare provider know.

Symptoms that warrant a call to your healthcare provider include:

• Worsening chest pains
• Difficulty breathing with exertion or at rest
• An increase in abnormal heartbeats
• Racing heartbeat or heart palpitations
• Waking up at night with coughing or trouble breathing
• Fainting

Heart Disease and Postpartum

Pregnancy puts added stress on the heart. When a person with heart disease makes it through a pregnancy and delivery without any apparent complications, it suggests that their heart was able to withstand the stress of pregnancy.

However, heart complications, or a worsening of a heart condition, can show up at any time within a year postpartum—even if a person had an apparently normal pregnancy.

Your care team will want to monitor you closely during the months after you give birth to watch for any lingering effects of pregnancy on your heart and body.

Recovery

After giving birth, the body needs time to recover from the intense physical experience, which can be particularly true for people with heart disease.

The amount of blood that your heart pumps per minute will likely get back to normal within a few weeks postpartum, but experts estimate that it may take anywhere from four to six months (or longer) for the heart-related changes of pregnancy to resolve. The timing depends on the type of heart disease that a person has.

In rare cases, some people develop postpartum cardiomyopathy (or peripartum cardiomyopathy), a form of pregnancy-associated heart failure. It usually happens in the last month of pregnancy but can occur up to five months postpartum.

The cause of postpartum cardiomyopathy is unknown, but it can be temporary, permanent, or even life threatening. People who develop postpartum cardiomyopathy usually do not have a previous history of underlying heart disease or any obvious risk factors.

Lactation

Nursing the baby is recommended for most people with heart disease. Some recent studies have indicated that nursing is beneficial for the heart. It’s also been linked to a lower risk of developing diabetes, high cholesterol, high blood pressure, and heart disease later in life.

If you plan to nurse your baby, you’ll want to discuss a few things with your healthcare team first. Talk to your healthcare provider before you start nursing if you:

• Take medication for a heart condition
• Have a congenital heart condition that increases your risk of endocarditis (a serious infection or inflammation of the heart)

Frequently Asked Questions

How do you reverse heart disease?

In some cases, damage that is caused by certain heart conditions—such as congestive heart failure and coronary artery disease—can be reversed with lifestyle and nutrition changes.

Your healthcare provider might recommend exercising, eating a heart-healthy diet, stopping smoking, managing stress, and taking medication.

What are the early signs of heart disease?

Different kinds of heart disease produce different symptoms. The most commonly reported are:

• Chest pain or discomfort
• Palpitations
• Lightheadedness or dizziness
• Fainting
• Fatigue
• Shortness of breath

Sometimes, heart disease does not cause any noticeable symptoms at all, especially if it’s in the early stages.

The signs of heart disease can also look different in people with vaginas than in people with penises. For example, those assigned female at birth may have pain in the neck, jaw, throat, upper abdomen, or back, and they may experience fatigue and nausea or vomiting.

Why is physical activity so important for preventing heart disease?

Physical activity is essential for preventing heart disease because it helps keep your heart and blood vessels healthy.

Exercise helps by raising your HDL (or “good”) cholesterol levels, aiding in weight management, lowering your blood pressure, and controlling your blood sugar—all of which can help reduce your risk for heart disease.

How does diabetes affect heart disease?

People with diabetes are more likely to develop heart disease, stroke, and heart failure than people who do not have diabetes.

Having diabetes raises the risk for heart disease because it is linked to high blood pressure, too much LDL (or “bad”) cholesterol, and high triglycerides.

Over time, high blood sugar can also damage the blood vessels and nerves related to your heart.

A Word From Verywell

Heart disease during pregnancy is a unique experience for each individual, but if you have it, know that you’re not alone. You will be closely monitored by your cardiologist and OB-GYN before, during, and after pregnancy.

Social support is also a key component to coping with heart disease during pregnancy. In addition to your family and friends, you can find support from the American Heart Association’s Go Red for Women support network, WomenHeart, or your local healthcare system, which may offer online or in-person community support groups.