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    Heart Disease During Pregnancy

    Dr. Brennan Fitzpatrick, MD, MBA, FACOG Maternal Fetal Medicine Specialist at Tri-State Perinatology at The Women’s Hospital 02/12/2019
    A mother’s heart is a precious thing. For all of us, the heart is the most recognizable symbol of health and vitality. For an unborn child, a mother’s heart is its lifeline- the engine that drives the pregnancy.  Every beat delivers essential nutrients and oxygen to the fetus via the placenta while whisking away suffocating carbon dioxide and waste.  In pregnancy, a mother’s heart truly does beat for two.  At the beginning of pregnancy, a woman’s heart and circulatory system begin a miraculous process of change that will enable them to support another life for 40 weeks.  The amount of blood in a mother’s body increases by almost 50%.  The heart itself changes and grows.  The muscular pumping chambers of the heart, called ventricles, become larger, and the heart begins to contract more efficiently.  The circulatory system which is composed of all of our blood vessels, large and small, relaxes leading to lower blood pressures.  As blood pressure decreases, Mom’s heart rate increases, many times reaching 100 beats per minute at rest. All of these changes increase the workload for the heart, but ensure that the placenta, which connects mom to baby, receives adequate blood flow.  For a mother with a normal heart, these changes are well tolerated; however, for a mother with heart disease these changes can put both mom and the pregnancy at risk.

    Caring for mothers with heart disease in pregnancy can be simple and straightforward or exceedingly complex.  The level of risk for a pregnant mother with heart disease is generally determined by the type of heart disease that the mother has and the types of symptoms that a mother has both at rest and with activity. All pregnant patients with heart disease should be managed using something called a multidisciplinary care model.  Multidisciplinary care teams generally include the patient’s general obstetrician, a high-risk obstetrician, a genetic counselor, a cardiologist or a more specialized cardiologist called an adult congenital heart specialist, anesthesiologists, as well as a support team of nurses and technologists. This multidisciplinary team works together to ensure that both mother and baby remain safe throughout the pregnancy. They create a plan intended to reduce risks to mother during the pregnancy, at the time of labor and delivery, and after the baby is born. Sometimes those plans include early delivery, and sometimes those plans require delivery at a center capable of providing more specialized care for moms with heart disease. Unfortunately, some women with heart disease should not get pregnant.  It is important that all women with heart disease meet with a high-risk obstetrician (also known as a maternal-fetal medicine specialist or perinatologist) prior to pregnancy to discuss risks at length.  In some cases, surgery prior to pregnancy may allow women who are not candidates for pregnancy to safely move forward with getting pregnant. A maternal-fetal medicine specialist can help a patient considering pregnancy make these important decisions.
     
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