“Eating for two” is a common expression regarding pregnancy, but what about ”beating for two”? When you’re pregnant, your heart is working extra hard to support an additional life. For some women, that extra work puts significant strain on their heart; in fact, developing heart problems during pregnancy is surprisingly common.
In this video, San Diego Health host Susan Taylor talks with Poulina Uddin, MD, a cardiologist at Scripps Clinic and Sean Daneshmand, MD, an OB-GYN at Scripps Clinic, about pregnancy and heart problems that can affect both mom and baby.
Because your heart is working for more than one person during pregnancy, it must support a lot of extra blood volume. The result is increased stress, pressure and demand to pump blood, which can lead to hypertension or high blood pressure during pregnancy.
High blood pressure is a problem that many people have whether they’re pregnant or not. If a woman has high blood pressure before she becomes pregnant, her heart is already working harder to deliver blood to the body, and pregnancy increases that workload. When high blood pressure develops during pregnancy, it may be a sign not only of increased blood volume but also of inflammation, which can cause the vessels to either narrow or expand and affect the mother’s blood pressure.
Blood pressure that is very high and not controlled can lead to preeclampsia, a condition where blood pressures rise on top of pre-existing elevated blood pressures. This, in turn, can cause fetal growth restriction, meaning the baby is not developing well in the uterus.
“Remember the baby is basically surviving based on what mom does. So all the nutrients and oxygen are being exchanged between baby and mom via the placenta,” says Dr. Daneshmand, who is medical director of the Scripps Perinatology Program for women with high-risk pregnancies. “Any time you have elevation of the blood pressure, it causes something we call uteroplacental insufficiency, or reduced exchange between mom and baby.”
Severe preeclampsia may lead to premature delivery of the baby. Depending on the severity and when the mother is diagnosed with preeclampsia and the severity of her condition, the baby may be delivered at 37 weeks, which is three weeks prior to their due date, or within 24 to 48 hours after their diagnosis.
Ideally, doctors want to treat high blood pressure before pregnancy, especially if the woman has other risk factors, such as being 35 or older (known as advanced maternal age), having a family history of heart problems, or having diabetes.
“There are things that we can do naturally to lower blood pressure, such as weight loss, exercise, avoiding certain types of foods,” says Dr. Uddin. “Some people end up needing blood pressure medications. Some are safe to use in pregnancy, others are not, so that’s certainly something we want to address.”
Congenital heart defects are heart problems that are present at birth, such as a valve that doesn’t close properly or a hole in the heart.
“Congenital heart disease could mean a number of things. Some are important and need surgical correction, and others you just monitor and they don’t necessarily harm the mom or the baby,” says Dr. Uddin. “But we do know that there is a slight increased risk of passing a heart defect along to the baby, so these women also need extra care and maybe even a scan of the baby’s heart while they’re pregnant to identify possible defects early.”
“The most important thing you can do is to make sure you see your provider to talk about your medical history, your surgical history, your family history, the medications you use in order to optimize your health prior to getting pregnant,” says Dr. Daneshmand.
This is especially true if you have high blood pressure, diabetes or other chronic conditions that may raise your risk of complications during pregnancy.
The Scripps Pregnancy Heart Program is a collaboration between Scripps obstetricians, maternal fetal medicine and cardiology to provide comprehensive, compassionate cardiac care for women and their babies before, during and after pregnancy through a multidisciplinary, team-based approach.
“We are very keen on continuing to follow these high-risk women after they are no longer pregnant,” says Dr. Uddin. “We’re happy to take care of these women at any stage in the game, whether it’s pre-pregnancy, during pregnancy, and certainly postpartum and long-term follow up.”