Frequently Asked Questions for Pregnant Women with Congenital Heart Disease
If you have adult congenital heart disease (ACHD), you might wonder how it will affect your ability to have children. Many women with ACHD can have healthy pregnancies. Plan carefully and work closely with your doctors. Experts from the Adult Congenital Heart Disease Program at Cincinnati Children’s answer questions about adult congenital heart disease and pregnancy.
How does ACHD affect pregnancy?
ACHD means you were born with a heart defect, and it can affect how well your heart works. Pregnancy puts extra strain on the heart because it needs to pump more blood to support both you and your growing baby. Your heart has to beat harder and faster throughout pregnancy. For women with ACHD, this extra work can sometimes be too much. This depends on the type of heart defect and how well it has been managed.
Before trying to get pregnant, talk to your cardiologist (heart doctor). They can help you understand how your heart condition might affect pregnancy and whether it’s safe for you. Some women with ACHD may need special care or treatment through a cardio-obstetrics program to make pregnancy safer.
I have congenital heart disease. Can I expect to have a healthy pregnancy?
Pregnancy is safe for most women with congenital heart disease. Some heart conditions have more risk than others. Your doctor will help you understand if pregnancy is safe for you. In some cases, women with severe heart defects or who have had surgeries like the Fontan procedure may face higher risks during pregnancy. This doesn’t mean pregnancy is not possible, but it does mean extra care is needed.
Your doctor might discuss whether you need to change any medications before or during pregnancy. Some heart medicines are not safe for pregnant women.
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 gets ready to give birth, extra hormones are released that make the heart pump stronger. These hormones can make the heartbeat abnormal and go too fast.
The mother’s body prepares for giving birth by making it easier for their blood to clot. Some women with congenital heart disease are at a higher risk for blood clots. Medications can help manage this.
Your doctors will monitor your blood pressure, oxygen levels and heart function. Depending on your heart condition, you might need to see your heart specialist more often during pregnancy than usual.
What can I do to make sure I have a healthy pregnancy?
When you become pregnant, you’ll need to work closely with a healthcare team that specializes in high-risk pregnancies. They will make sure your heart is healthy enough for pregnancy and monitor both you and your baby throughout.
The best way to prepare for pregnancy with ACHD is to plan ahead. Here are some steps you can take:
Plan when you become pregnant. Talk with your cardiologist about what birth control methods are safe and work for you. Planning pregnancy when your heart health is at its best will give you the best chance for a healthy pregnancy and baby.
Talk to your cardiologist (heart doctor). Before becoming pregnant, make sure your heart is in the best shape possible. Your doctor may run tests, like an echocardiogram or stress test, to see how well your heart is working.
Work with a high-risk pregnancy team. Find a doctor who specializes in high-risk pregnancies. Look for a doctor who has experience working with pregnant women with heart conditions.
Manage your health. Follow a healthy diet, stay active (as recommended by your doctor) and avoid smoking or drinking alcohol. Keeping your heart healthy will help reduce the risks during pregnancy.
When considering pregnancy, consider the risk to the baby and the risk to the mother. Women with ACHD should meet with their cardiologist to make sure their hearts are healthy enough to handle a pregnancy. To help protect their health, some women may need a procedure before they get pregnant, like a valve repair or a surgery to help treat an arrhythmia.
What are the low-, medium- and high-risk groups for a woman with a congenital heart defect?
The risks for a woman with a congenital heart defect during pregnancy are different depending on their condition.
Here’s a breakdown of the risk groups:
- Low risk. Women who had a hole in the heart that was repaired, like an atrial or ventricular septal defect (ASD or VSD). These defects are generally considered low risk for pregnancy.
- Medium risk. Women with more complex heart defects that have been repaired. These include tetralogy of Fallot or transposition of the great arteries.
- High risk. Women who are already having heart failure or other serious heart problems are in the high-risk group. This includes those with conditions like severe aortic stenosis, pulmonary hypertension, cyanosis (low oxygen levels in the blood) or an aortic aneurysm.
How will you know that my pregnancy is on track? What if there is a problem?
We closely check how your heart looks and how you’re feeling throughout your pregnancy. This includes regular heart exams and monitoring to make sure everything is OK. If we spot a problem, we’ll address it as soon as possible. Our goal is to make sure you and your baby are well cared for, so we’ll have experts ready to step in if needed.
What does the treatment plan look like?
Your treatment plan will cover four important stages: before pregnancy, your pregnancy, giving birth, and the time after you give birth.
- Before pregnancy. Your cardiologist may perform extra tests before you become pregnant. Your doctor will talk to you about a birth control plan and what is safe for your heart condition. Your doctor will also review any medications that may need to be stopped prior to becoming pregnant (like some blood pressure medications).
- During pregnancy. You’ll have regular checkups and tests, like echocardiograms, to see how your heart is working. These tests will look at your heart’s size, strength, valves and rhythm. Because your heart is working harder, you may need medication to control symptoms like high blood pressure.
- Giving birth. We’ll plan how to best manage your heart condition when you give birth. This plan includes the type of pain medication that is safe for you. We'll decide whether it’s better for you to have a vaginal birth or a cesarean section.
- After giving birth. After your baby is born, you’ll likely continue with medications. You'll have follow-up visits with your cardiologist and other specialists to make sure you’re recovering well.
Are there risks for my baby?
In a small number of cases (3-4%), congenital heart disease may be passed from mother to the baby. Your condition may affect your health during pregnancy. Your baby could be born early or smaller than expected. Some medicines you take also might affect your baby. Discuss all medications with your doctor to make sure everything is safe.
What if I’ve already had a child with a congenital heart defect?
If you’ve had a child with a congenital heart defect before, your doctor may recommend a fetal echocardiogram, or echo, for future pregnancies. This special ultrasound lets us check your baby’s heart while still in the womb. Some types of congenital heart defects can be linked to genetic conditions, so it’s important to closely monitor the baby’s heart development.
What if one of the parents has congenital heart disease?
If either of the parents has congenital heart disease, a fetal echocardiogram is recommended for the baby during the second trimester.
What happens after pregnancy?
After you give birth, your body will take time to recover, and your heart will need to adjust back to normal. Some mothers may need to stay a few extra days in the hospital to make sure everything is going well.
You’ll need to continue seeing your cardiologist after delivery. You may have heart-related issues after you have your baby. Your doctor will monitor your heart and prescribe any medications or treatments you may need.
If you have ACHD and plan to breastfeed, talk to your doctor about whether any medications you take could affect breastfeeding.
