Pregnancy can be a wonderful experience, but it also can also be challenging on your heart.
In the first three months of pregnancy, the amount of plasma and red blood cells increase by about 50% and 25% respectively, forcing your heart to work harder to pump the extra blood. For moms-to-be who have heart conditions, pregnancy may increase the risk of complications.
Fortunately, most women depending on the heart condition, can have healthy pregnancies and healthy babies when they understand their risks and work with their physician to manage them.
Whether a woman has high blood pressure (also called hypertension) before she becomes pregnant or develops it during pregnancy, it can raise the risk of complications for both mother and baby.
Development of high blood pressure in a woman with normal blood pressure prior to pregnancy may lead to a serious condition called preeclampsia. Preeclampsia may occur during pregnancy typically after 20 weeks of gestation or up to six weeks after delivery. It affects 8 to 10% of pregnancies.
The diagnosis of preeclampsia is based on high blood pressure and increased protein in the urine of the mother. Because pregnant women usually have no way of knowing if they have high blood pressure or protein in their urine, it’s important to keep all prenatal appointments.
An obstetrician also can identify other signs and symptoms of preeclampsia that pregnant women may not realize are major concerns. These include:
- Swelling in the hands or face (non-dependent edema)
- Severe headache not responding to pain medication
- Rapid weight gain over a few days
- Pain in the upper right abdomen
- Changes in vision
- Continuous nausea or vomiting
The severity of preeclampsia depends on the mother’s blood pressure levels, symptoms and blood work.
Preeclampsia without severe features (previously known as mild preeclampsia) occurs when blood pressure is between 140-159/80-109 mmHG without any symptoms nor significant blood work abnormalities.
In preeclampsia with severe features (previously known as severe preeclampsia), blood pressure is typically equal to or above 160/110 mmHg. These women may have severe headaches not responsive to pain medication or laboratory abnormalities in severe range.
“Women who develop preeclampsia without severe features will need to be monitored more closely throughout their pregnancy to ensure the disease does not progress to preeclampsia with severe features,” says Sean Daneshmand, MD, an OB-GYN and medical director of the perinatology program for women with high-risk pregnancies at Scripps Clinic.
“If it does progress, the mother risks developing eclampsia, a serious and even life-threatening seizure disorder or other complications affecting the fetus and the mother. If the pregnancy is far enough along, the treatment for preeclampsia is to deliver the baby.”
Gestational hypertension is a disease similar to preeclampsia with the same blood pressure criteria. The difference in diagnosis is the lack of increased protein in the moms’ urine.
In both preeclampsia and gestational hypertension, blood pressure typically returns to normal after the baby is born up to 12 weeks after delivery.
High blood pressure during pregnancy in women with pre-existing hypertension can also be harmful for the baby. One concern is fetal growth restriction, which means the baby is smaller than they should be and may need specialized care during or after delivery. Another possible complication is a life-threatening condition called placental abruption in case of severe hypertension, where the placenta separates from the uterine wall.
“It’s important for women with high blood pressure to try to get it under control before becoming pregnant,” says Poulina Uddin, MD, a cardiologist who specializes in women’s heart care at Scripps Clinic Anderson Medical Pavilion in La Jolla.
“Talk with your doctor about your blood pressure and any other health concerns you may have.”
While hypertension is the most common heart concern during pregnancy, other conditions may warrant extra attention. These include:
Congenital heart disease and congenital heart defects refer to problems with the heart’s structure that are present at birth.
Some congenital heart defects change the normal flow of blood and may be a concern during pregnancy, when blood volume increases; for example, a heart valve problem that affects blood flow may raise the risk of complications during pregnancy.
Heart failure prevents the heart from pumping as well as it should. Since the body produces more blood during pregnancy, congestive heart failure may worsen.
If you take medications to manage a heart condition, they can affect your baby. Be sure to let your doctor know about any prescription or over-the-counter drugs or supplements you use. Your care team will let you know if you need to modify your dose or take a different medication during pregnancy.
“We know that women with some of these complications, such as preeclampsia, hypertension and diabetes during pregnancy, are at increased risk of cardiovascular event later in life, so these are important risk factors that should warrant a long-term relationship and follow up with a cardiologist as well, even after the pregnancy is over,” says Dr. Uddin.
Dr. Daneshmand agrees. “Women who have high blood pressure or other heart conditions should have specialized care if they’re pregnant or planning to become pregnant,” says Dr. Daneshmand.
“The Scripps Pregnancy Heart Program is a collaborative effort between your obstetrician, maternal-fetal medicine physician and cardiologist to ensure the best outcome for mom and baby.“