Heart conditions are a leading cause of maternal death associated with
pregnancy, and they are seen in up to one in 25-50 pregnant women. If you have a heart disease, you may be considered high-risk and working closely with a high-risk obstetrician (perinatologist or Maternal-Fetal Medicine specialist and a cardiologist will help you to achieve a good outcome for you and your baby.
Because there are different kinds of heart disease, and you haven’t mentioned which one you have, it’s difficult to give you more specific information related to your condition.
It used to be that over 90% of pregnant women with heart disease had ‘rheumatic heart disease’, injuries of the heart and heart valves brought upon by rheumatic fever. Rheumatic fever is a rare but potentially life-threatening infection and complication of untreated strep throat, caused by streptococcus A bacteria. Because of improved care and antibiotic treatment the number of pregnant women with heart disease due to rheumatic fever has decreased significantly over the last decades. Today, the most common form of cardiac disease in pregnant women are congenital heart conditions, which are seen in over 1 in 3 women with heart disease in pregnancy.
The first symptom of a heart condition is usually shortness of breath, dizziness, or chest pain. Many pregnant women normally complaint about occasional shortness of breath, the inability to get enough air in, dizziness, and the inability to perform certain physical exercises. These complaints are usually normal and due to the increased load of blood volume on your heart, which increases up to 50% by the 28th weeks of pregnancy. If you have a weakened heart, it sometimes cannot tolerate the increased stress of pregnancy and becomes unable to function well.
Unfortunately, the same normal pregnancy symptoms can also mimic heart disease in pregnancy, and it can sometimes be difficult to distinguish what’s normal and what’s abnormal in pregnancy.
How will you know that your symptoms are normal?
Let your doctor know right away if you:
A physical examination by your doctor will usually exclude heart disease. Sometimes an ultrasound examination of your heart called ‘echocardiogram’ is indicated to check your heart.
If a heart condition is diagnosed it’s classified:
Below is a table that shows a list of possible forms of heart disease:
New York Heart Associations’ Functional Classification of Heart Disease
Class I No limitation of activities; no symptoms from ordinary activities.
Class II Slight, mild limitation of activity; comfortable with rest or with mild exertion. More than ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain
Class III Marked limitation of activity; comfortable only at rest. Less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain.
Class IV Confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased
Over 90% of all heart conditions in pregnancy are class I or II and are therefore not involved with any significant risks. while women with class III and IV heart disease have increased complications, and frequent hospital admissions may be indicated.
Most of the more severe conditions are diagnosed before pregnancy, and it’s unusual to first diagnose a severe heart condition in pregnancy. One of the more severe but very rare heart conditions, called ‘peripartum cardiomyopathy’, is seen only late in pregnancy, and after delivery. Only a few heart diseases are so severe that pregnancy is associated with a very high mortality rate to the mother. (see table below)
Table: Maternal Mortality Associated with Specific Cardiac Lesions
Low risk of maternal mortality (<1%) Most Class I or II lesions of New York Heart Association (NYHA); Patent ductus arteriosus; Pulmonic/ tricuspid lesions; Septal defects
Moderate risk of maternal mortality (5%-15%) Most Class III or IV NYHA lesions, especially mitral stenosis; Tetralogy of Fallot Aortic stenosis; History of Myocardial Infarction (heart attack); Marfan syndrome with normal aorta;
High risk of maternal mortality (25%-50%) Eisenmenger's syndrome; Marfan syndrome with abnormal aortic root; Peripartum cardiomyopathy; Pulmonary hypertension
Heart disease can not only affect the mother’s body, but it can also affect the fetus. If the mother’s heart is unable to supply enough oxygen and other nutrition to fetus, the fetus will not grow enough and develop a condition called ‘intrauterine growth restriction’.
Here are some general guidelines for women with known heart disease in pregnancy: