Managing heart conditions in pregnancy

We talk to Roshni Patel, Consultant in Maternal Medicine & Obstetrics At Chelsea and Westminster NHS FT, London, about managing heart conditions in pregnancy

Dr Roshini PatelIf you were born with a heart condition (also known as a congenital cardiac condition), you may be at greater risk of problems whilst you’re pregnant. For all women, the heart has to work harder during pregnancy to support the 50% increase in blood volume and the developing baby. These changes start very early in pregnancy and for women with a congenital heart condition or have developed one later in life, this can put even more strain on the heart.

So, it’s very important to mention any heart conditions that you have or that run in the family when you meet your midwife, and have a conversation about additional investigations or monitoring that you will require. Depending on the condition, you may need to be referred to a high-risk obstetrician and a cardiologist who has experience in treating pregnant women. You may even need to be referred to a specialist pregnancy cardiac team (even if it is at some distance from your local hospital) and attend regular checks there. You can anticipate needing many more appointments and scans compared with someone with no medical conditions. Your medication will be closely monitored and adjusted if required. For example, some medication for high blood pressure (such as ACE inhibitors) cannot be used during pregnancy. Each person will be different, but pregnancy could lead to arrhythmia (a very fast or irregular heartbeat), shortness of breath or chest pain.

There is a risk that your cardiac condition could affect your baby’s health. For example, they might have a lower birth weight or need to be born prematurely. You may have more frequent scans from about 28 weeks to ensure that your baby is growing well. It is important to remember that the majority of babies born to women with cardiac conditions have no problems and are born after a 9  month pregnancy.

Cardiac conditions are common. Even if the parents do not have a cardiac condition there is a 1% risk of the baby being born cardiac condition. But with most other congenital conditions, which are not genetically transmitted, the chance of the baby having a heart condition is only about 3-5%. Some cardiac conditions are inherited, such as Marfan’s syndrome; 50% of children with a mother or father with this condition will inherit the condition.

When giving birth, you will be under the care of an obstetrician and will need to be closely monitored. Quite often, women can await labour to start naturally and do not need to be induced early. You will need to deliver on a labour ward and a pool or home birth will not be possible. You will almost certainly be given an epidural to limit the stress on your body and may also need a ventouse delivery to reduce the exertion in labour. Many women with cardiac conditions need to stay in hospital for a couple of days longer after the birth so that the medical team can see that their heart is returning to its pre-pregnancy condition. Having a cardiac condition does not interfere with a mother being able to breastfeed.

If you are not pregnant and have a cardiac condition, it is best to see your GP about referral for a pre-pregnancy counselling appointment to get more detailed information from an obstetrician/cardiologist and allow time for any changes in medication or investigations to be performed before you conceive.