Pregnancy in Women with Congenital Heart Disease

Most women with congenital heart disease are able to have a healthy and successful pregnancy. But careful evaluation before pregnancy and surveillance throughout pregnancy and after delivery are essential.

Our Adult Congenital Heart Disease (ACHD) Program is dedicated to ensuring the best pregnancy care and outcomes for women living with congenital heart conditions. We also care for women with other cardiovascular disease including acquired valvular heart disease, cardiomyopathies, heart rhythm disorders and connective tissue disorders (e.g. Marfan syndrome).

Our Comprehensive Assessment

Our pre-pregnancy assessment helps you better understand the potential impact of pregnancy on your health and the potential risks to your unborn baby. This assessment includes:

• A clinical history and physical examination
• An assessment of your cardiac reserve, often with an exercise test
• An electrocardiogram – a test that records electrical activity of the heart and identifies rhythm abnormalities
• An echocardiogram – an ultrasound test that uses high-frequency sound waves to view the heart and helps diagnose heart problems
• Family history and genetic testing – screening that helps CHD patients understand how their diagnosis may affect other family members

Our approach is to provide a comprehensive and integrated assessment of the mother’s cardiovascular reserve, which is the ability of the heart to work harder during strenuous physical activity. This helps us understand the risk for both mother and baby during pregnancy, which itself requires increased work from the heart and circulatory system.  

Our experts collaborate seamlessly with an array of specialists to ensure the best possible care. These include maternal-fetal medicine specialists, fetal cardiologists, fetal surgeons, genetic counselors, endocrinologists, electrophysiologists and many others.

When there is concern about the fetus, our specialists can draw on the extensive resources available through our Fetal Heart Program and Fetal Care Center. The Fetal Care Center is one of the few comprehensive fetal care programs in the country. 

Already Pregnant?

For women who are already pregnant, we offer outpatient and inpatient assessments to:

• Assess the status of the underlying heart condition
• Assess the mother’s obstetric risk, and identify ways to lower that risk
• Evaluate the baby’s specific needs 

Our team will follow you closely throughout pregnancy. We partner with obstetrician/maternal-fetal medicine groups throughout the area in multidisciplinary clinics to see you at the same time as their team to craft the safest pregnancy plan for you. 

Pregnancy FAQs

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 make sure I have 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 cardiologist (heart 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 cardiologist 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 groups for a woman with a congenital heart defect?

Examples include:

• Low risk: Women born with a hole in the heart, which was repaired. Examples are atrial or ventricular septal defects.
• Medium risk: Women born with Tetralogy of Fallot or transposition of the great arteries, which 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 that my pregnancy is on track? What if there is a problem?

We check how your heart looks and how you feel throughout your pregnancy to make sure everything 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 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 birth 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 high blood pressure or heart failure symptoms, like retaining water due to the increased 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 C-section birth is best for you

Your treatment plan after giving birth may involve:

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

Are there risks for my baby?

In a small number of cases (3-4%), 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 have a fetal echocardiogram in future pregnancies. Some types of congenital heart defects are more likely to be associated with an underlying genetic condition.