heart in pregnancy

Overview

Pregnancy puts extra work on your heart. For most women, this is normal and safe. But some women have or develop heart problems during pregnancy that need special care to keep both mother and baby healthy.

Heart problems are not common during pregnancy, affecting about 1-4% of pregnancies. But they are a leading cause of serious pregnancy complications, so it is important to be aware.

It can affect any pregnant woman, but it is more common in women over 40, those with pre-existing heart conditions (like congenital heart disease or heart valve problems), women with high blood pressure or diabetes, and those carrying more than one baby.

Symptoms

Common symptoms

• Shortness of breath that gets worse with activity or when lying down
• Swelling in the legs, ankles, or feet (more than usual pregnancy swelling)
• Palpitations – feeling like your heart is racing, fluttering, or skipping beats
• Extreme tiredness or weakness
• Chest discomfort or pressure

Symptoms in children

• This topic is about the pregnant person, not children. If you are concerned about your child's heart, talk to your pediatrician.

Symptoms in older adults

• This topic is about pregnancy, which typically affects younger adults. Older pregnant women (over 40) may have higher risk and need closer monitoring.

Causes

Main causes

• Pregnancy itself: increased blood volume and heart rate put extra strain on the heart.
• Pre-existing heart conditions, such as congenital heart defects, valve disease, or cardiomyopathy.
• High blood pressure during pregnancy (preeclampsia) can affect the heart.
• Infections that inflame the heart muscle (myocarditis) – rare but serious.

Risk factors

• Having a heart condition before pregnancy
• Being over 40 years old
• Having multiple pregnancies (twins or more)
• Obesity or being very underweight
• Diabetes or high blood pressure
• Smoking or using alcohol during pregnancy

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above, call your local emergency number immediately.
• If you have sudden or severe symptoms like chest pain, severe shortness of breath, or fainting, do not wait – get help.
• If you have a known heart condition and notice new or worsening symptoms, contact your doctor right away.

Book a routine appointment if:

• See your midwife or obstetrician regularly for all prenatal checkups.
• If you have a heart condition, you may need to see a cardiologist (heart doctor) regularly during your pregnancy.
• Talk to your doctor about any concerns, even if they seem minor.

Diagnosis

Your doctor will start with a detailed history and physical exam, listening to your heart and lungs. Based on your symptoms, they may order tests to check your heart function.

Tests that may be done

• Electrocardiogram (ECG) – a quick, painless test that records your heart's electrical activity.
• Echocardiogram – an ultrasound of your heart to see how well it is pumping and check your heart valves.
• Blood tests to check for signs of heart strain or other problems.
• Sometimes a Holter monitor – a portable ECG you wear for 24-48 hours to track your heart rhythm.

What to expect at your appointment

If your doctor finds a heart problem, you will be referred to a specialist team that includes a cardiologist and an obstetrician who manage high-risk pregnancies. They will work together to monitor you and your baby closely throughout pregnancy and after birth.

Treatment

Treatment focuses on managing any heart condition while keeping you and your baby safe. The approach depends on the specific problem and how it affects you. Your healthcare team will tailor a plan just for you.

Self-care at home

• Get plenty of rest and listen to your body – do not overdo it.
• Eat a healthy, balanced diet with less salt to help control blood pressure.
• Avoid smoking, alcohol, and any recreational drugs.
• Stay active with gentle exercise like walking, but check with your doctor first.

Medical treatments

Your doctor may prescribe medications to help your heart pump better, lower blood pressure, or control heart rhythm. Some medicines are safe during pregnancy, but always follow your doctor's advice and do not stop or start any medication without checking. In some cases, you may need to be admitted to the hospital for close monitoring.

When is surgery considered?

Heart surgery during pregnancy is very rare and only done for severe life-threatening problems, such as a faulty heart valve that cannot wait. Usually, surgery is done before or after pregnancy if possible.

Living with this condition

While pregnant, take things slowly. Keep all your medical appointments, and call your doctor if anything feels wrong. After delivery, most women continue to need follow-up care because the heart can take several months to return to pre-pregnancy state.

Lifestyle tips

• Plan rest breaks during the day.
• Avoid heavy lifting or strenuous exercise unless your doctor says it's okay.
• Manage stress with relaxation techniques like deep breathing.
• Ask for help from family and friends – you do not have to do everything.

Diet and exercise

Eat a heart-healthy diet with plenty of fruits, vegetables, whole grains, and lean protein. Limit salt and processed foods. Gentle exercise like walking or swimming is usually safe, but always check with your healthcare team first. Stay hydrated.

Mental health and emotional wellbeing

Worrying about your heart and your baby's health can be stressful and may cause anxiety or depression. It is normal to feel this way. Talk to your doctor or midwife about your feelings – they can help connect you with support.

Prevention

You cannot always prevent heart problems during pregnancy, but you can reduce your risk by staying healthy. If you have a known heart condition, talk to your doctor before becoming pregnant to plan the safest pregnancy possible.

Vaccines

Keep up with recommended vaccines during pregnancy, such as flu and whooping cough vaccines, to prevent infections that could stress your heart.

Screening programmes

Women with risk factors (like pre-existing heart disease or high blood pressure) may benefit from a heart check-up before pregnancy. During pregnancy, routine blood pressure and urine checks help detect problems early.

Complications

If left untreated

• Heart failure – the heart cannot pump enough blood to meet the body's needs.
• Severe high blood pressure (preeclampsia) that can harm both mother and baby.
• Premature birth or low birth weight.
• Stroke – very rare but serious.

Long-term outlook

With regular care from a specialist team, most women with heart problems during pregnancy have a successful pregnancy and a healthy baby. After delivery, your heart will be monitored to make sure it recovers well. Many women go on to have normal heart health over time.

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