Pregnancy is a time when you focus on a heart-healthy lifestyle. The changes your body goes through for the next nine months will stress your heart and circulatory system. In fact, cardiac disease is the most common cause of mortality in pregnancy. However, a woman’s body is designed to withstand this surge of cardiac load, and it’s still possible for women with heart conditions to have a successful delivery and healthy babies with proper care. 

Concerns about cardiac health highlight the importance of being aware of the risks and how to prevent complications. 

Your Heart During Pregnancy

Pregnancy increases your blood volume by a whopping 50 percent as your body accommodates your growing baby. These changes put extra stress on a woman’s body with profound effects on your cardiovascular system. With increased cardiac output, your heart rate at rest also increases by up to 30-50 percent.  

Labor and delivery also add to your heart’s workload. The demand for your heart increases during contractions and as labor advances. Furthermore, bearing down during delivery can cause a sudden change in blood flow and pressure, and it will take a few weeks before your heart reverts back to its pre-pregnancy state. Blood loss during delivery can also place an intolerable strain on an abnormal heart. 

Pregnancy increases your blood volume by a whopping 50 percent as your body adjusts to support your growing baby.

Pregnant women with congenital heart disease (CHD) have a higher risk of developing complications during pregnancy and delivery, especially if they have other pre-existent diseases. Depending on the type and severity of the disease, some of these heart conditions may pose life-threatening risks to the mother or the baby. Therefore, some women are required to undergo major treatments before they conceive, or they are advised to avoid pregnancy if they’re dealing with a rare congenital condition. 

Preparing Your Heart for Motherhood

Women of reproductive age with congenital or acquired heart disease must have access to specialised multidisciplinary preconception counselling to empower them to make choices about pregnancy. 

If you’re among those who are at risk, it’s important that you consult your OB and cardiologist before trying to conceive. The management of high-risk pregnancies and deliveries are done on an individual basis.  It is aimed to optimise your condition during pregnancy, monitor for deterioration, and minimise any additional load on your cardiovascular system during delivery and the postpartum period. 

You will undergo a pre-pregnancy evaluation which involves a risk assessment for you and your baby. Your doctor will also review the management of your heart condition and consider the necessary changes before you conceive and to accommodate your future pregnancy. For instance, certain cardiac medications are not advised for pregnant women, but due to circumstances, your doctor might adjust the dosage or prescribe a substitute. 

If you were born with a cardiac abnormality and have undergone an operation to correct it, it doesn’t mean that you are off the hook. Surgery may leave some scarring to your heart which makes you more prone to infections and an irregular heartbeat.

If you were born with a cardiac abnormality and has undergone an operation to correct it, it doesn’t mean that you are off the hook.

To ensure you and your baby’s safety, you will have multidisciplinary care where you can expect frequent prenatal visits.  This involves:

  • Close monitoring of your weight, cholesterol, blood sugar and blood pressure
  • Measurement of body mass index in early pregnancy
  • Diet management
  • Development of a treatment plan that could run along the spectrum of usual labor and delivery procedures, even up to the postpartum period
  • Blood tests
  • Urine tests
  • Medications
  • Echocardiogram
  • Electrocardiogram

A Mom’s Healthy Heart Means Healthier Children

A woman’s cardiovascular health during pregnancy also affects the baby’s environment in the womb. Maternal heart disease may deprive the baby of optimum oxygen levels and nutrients as the heart is unable to pump blood efficiently. This can slow down fetal growth rates, and it is also associated with preterm delivery and low birth weight

Adopting heart-healthy habits and precautions while pregnant sets your baby’s heart health on the right foot. Researchers found that a heart-healthy lifestyle has a strong link to a child’s cardiovascular health in the long term.

Labour and Delivery

A discussion on labour and delivery in consideration of your heart condition is also necessary especially if you’re making a birth plan.

You need to give birth in a hospital with the appropriate facilities for monitoring. It is still best to wait for spontaneous labour, unless the baby has to be delivered early to avert maternal or fetal compromise.

Women with congenital heart disease won’t be automatically offered a caesarean section. However, it may be recommended so you can have pain-free labour. This will entail the use of an epidural to mitigate large fluctuations in your heart rate and blood pressure associated with the pain brought by uterine contractions. Your doctor may also use vacuum and forceps to assist you in delivery and avoid excessive straining to push the baby out. 

Take This to Heart, Mommy

Heart conditions and diseases may lead to a high-risk pregnancy, but adequate preparation on your end coupled with the right medical management are vital steps towards a positive outcome. The decisions you make now regarding your heart health and pregnancy can have effects on you and your baby later in life.

As you plan to grow your family, start your preparations with professional help. In Singapore, you can approach Dr. Pamela Tan for caring and individualised management.