Experts from the Adult Congenital Heart Disease Program at Cincinnati Children’s gives answers to questions about adult congenital heart disease and pregnancy.

I have congenital heart disease. Can I expect to have a healthy pregnancy?

Pregnancy is safe for most women with congenital heart disease. There are some cases in which the mother would be in danger. We can help identify cases where pregnancy might have more risk, such as for women with a Fontan Circulation.

How does the heart change during pregnancy?

During pregnancy, a woman’s body makes more blood for the growing baby. The body adjusts. The heart gets bigger and pumps faster and harder. In women with congenital heart defects, pregnancy may strain the heart. This may cause it not to work as well. As the mother’s heart gets ready for giving birth, extra hormones are released that make the heart pump stronger. These hormones can make the heartbeat abnormal or faster.

The mother’s body prepares for giving birth by making it easier for their blood to clot. Some women with congenital heart disease get blood clots more than others. Medications can help manage this.

What can I do to ensure a healthy pregnancy?

The basic rules of health also apply for pregnancy. Do not smoke, eat a healthy diet, and get enough sleep. It is important to think about the risk to the baby and the risk to the mother when considering pregnancy. Women with congenital heart disease should meet with their adult congenital heart disease doctor to make sure their heart is healthy enough to handle a pregnancy. Some women may need a procedure before they get pregnant to help protect their health.

Lastly, women with congenital heart disease should notify their adult congenital heart doctor after becoming pregnant. Some women may need closer follow up for their heart during pregnancy. It may also be recommended to see a high-risk pregnancy doctor.

What are the low-, medium- and high-risk categories for a woman with a congenital heart defect?

Examples include:

• Low risk: Women born with a hole in the heart that was repaired. Examples are atrial or ventricular septal defects
• Medium risk: Women born with tetralogy of Fallot or transposition of the great arteries that was repaired
• High risk: Women with heart failure problems going into pregnancy. Examples are severe aortic stenosis, pulmonary hypertension, cyanosis, or aortic aneurysms

How will you know if everything is on track through my pregnancy? What if there’s a problem?

We check how your heart looks and how you feel throughout your pregnancy to make sure each thing is okay. If there is a problem, we can find it when we check you. We will treat it as early as possible. We plan ahead to make sure that experts are on hand to care for you and your baby. We work with experts such as obstetricians (doctors who deliver babies), surgeons and anesthesiologists (doctors who give sleepy air for patients having surgery).

What does the treatment plan look like?

You will have three plans: a pregnancy plan, a delivery plan, and a plan for after giving birth.

Pregnancy treatment plans involve:

• Visits for exams
• An echocardiogram to view the heart’s size, strength, valve function and rhythm
• Medications, if needed, to control any symptoms. Medications may control like high blood pressure or heart failure symptoms, like retaining water due to the increase workload of the heart.

Plans for giving birth may involve:

• How to manage your heart condition at the time of birth
• Types of anesthesia you can have
• Deciding if vaginal birth or cesarean section delivery is best for you

Your treatment plan after delivery may involve:

• Medications
• Follow-up appointments with your cardiologist or other experts

Are there risks for my baby?

In a small number of cases (three to four percent), congenital heart disease may be passed on to the baby. Sometimes, a mother’s heart condition may affect her baby. If the mother is unwell during pregnancy, her baby may be born early. The baby may be small at birth or may be medically frail. Some medications taken by mothers may affect their babies. It is important to talk about all medications with your doctor.

What if I’ve already had a child with a congenital heart defect?

If you’ve had a prior child with a congenital heart defect, you should likely be offered a fetal echocardiogram in future pregnancies.

Some types of congenital heart defects are more likely to be associated with an underlying genetic condition.