Heart Disease and Pregnancy

Often young women with cardiovascular disease are told that they should not become pregnant, when in fact, they may be able to undergo a safe pregnancy successful for both mother and baby. The Northwestern Medicine Heart Disease and Pregnancy Program at the Bluhm Cardiovascular Institute has nearly 25 years experience managing all forms of heart disease during pregnancy.

The Heart Disease and Pregnancy Program takes a multidisciplinary approach involving specialists from Maternal-Fetal Medicine (high-risk Obstetrics), anesthesia, obstetrics, cardiac genetics, and other medical subspecialties to provide comprehensive care for pregnant women with heart disease. Women that will benefit from this program include women born with heart disease, those that acquire heart disease prior to their childbearing years, and/or those that develop heart disease during pregnancy. Over 1,500 women have been followed in this program with all types of heart disease.

The purpose of the Heart Disease and Pregnancy Program is to provide specialized, appropriate care for the pregnant woman with heart disease. The goal is successful outcome for both mother and baby.

Preconception evaluation

Pregnancy places unique demands on the mother's circulatory system, which may cause problems if there is underlying heart disease. Heart problems during pregnancy may develop because of the cardiac changes associated with pregnancy or the pregnancy itself may be affected by the underlying heart problem. Therefore, it is important that women with heart disease have a complete preconception evaluation prior to becoming pregnant. This evaluation can be lifesaving and will certainly help to promote a successful pregnancy outcome. The Heart Disease and Pregnancy Program has developed strategies that are specific for different types of heart disease.

Heart problems during pregnancy

During pregnancy, there are changes that occur in the mother's circulatory system that are expected and normal. Because a mother's circulatory system is required to provide additional blood to the uterus and the placenta, her blood volume increases. The plasma (fluid in the blood) volume increases faster than the blood cells increase resulting in an anemia (lower than normal number of red blood cells) during pregnancy. Anemia can increase demands on the heart. The plasma volume increase begins early in pregnancy and reaches peak effects between 24 and 26 weeks. This plasma level change, when compared to the non-pregnant state, is increased by approximately 50 percent.

Later in pregnancy, the heart rate increases to promote circulation of blood to the uterus. The highest heart rates for the mother are in the last trimester. The heart rates may increase between 10 and 20 percent but the woman may not be aware of this change. The total cardiac output (volume of blood pumped out of the heart with each beat) increases in mid-pregnancy by up to 50 percent. In addition, it is normal during pregnancy for the blood vessels to dilate and the blood pressure to fall.