Posted Wednesday, February 13, 2013
February is American Heart Month
Margaret Miller, MD
While the idea of becoming pregnant with a heart condition might seem a little scary, Margaret Miller, MD, director of the Women’s Medicine Collaborative, says most women with heart disease – including conditions like arrhythmia, heart murmurs, mitral valve prolapse and high blood pressure – will have a healthy baby, especially if they receive the proper care and monitoring.
“There are still some who believe that women with heart disease or cardiac issues shouldn't get pregnant because it would be too risky. However, that’s definitely not the case. Heart disease and cardiac conditions can be safely managed during pregnancy,” says Miller, an obstetric medicine physician who cares for pregnant women with underlying medical conditions.
She recommends women with existing heart conditions carefully plan their pregnancies and be sure they are using an effective form of birth control until their disease is adequately controlled. It is also recommended that these women seek care from a multidisciplinary team of providers who have expertise in the management of cardiac issues in pregnancy.
“Women with heart conditions should consider a preconception consult, which will give the woman and her physician an opportunity to optimize cardiac function, discuss risks in pregnancy, review medications and make a plan for the pregnancy, as well as labor and delivery,” Miller says. “Many heart medications can be used safely during pregnancy, and in fact, untreated cardiac disease can pose a greater risk than most medications.”
According to Miller, pregnancy is associated with significant changes in the cardiovascular system. The heart rate increases by an average of 10 to 20 beats per minute, and because the heart is pumping more blood, the cardiac output is higher. These normal physiologic changes can cause many pregnant women to experience heart palpitations, or a fast heart rate, a common – yet harmless – cardiac “symptom.”
There is a heart condition specific to pregnancy called peripartum cardiomyopathy, which is a form of heart failure that can occur in the last month of pregnancy or early postpartum period. It is rare, but Miller says women who experience a significant and new onset of shortness of breath, palpitations, lightheadedness or chest pain in the end of pregnancy or postpartum should be checked by their physician as soon as possible.
While actual heart attacks during pregnancy are very rare, Miller says the rise in obesity and diabetes could lead to more cases in the future. “Most providers do not think about a heart attack in a young woman, but women who have new onset chest pain – especially if it is associated with shortness of breath, sweating, nausea or dizziness – should receive medical treatment right away,” she adds.
She also points out that women who have preeclampsia – a potentially serious condition in pregnancy characterized by high blood pressure, sometimes with fluid retention and protein in the urine – during their pregnancy have a higher risk of heart disease later in life.
“Knowing that preeclampsia can potentially ‘predict’ who might go on to develop heart disease, we can now be vigilant when it comes to screening and testing women with a history of preeclampsia in order to prevent the onset of disease,” Miller says.
Filed under: Women's Medicine Collaborative,