How Will Congenital Heart Disease Affect My Pregnancy?

The short answer is: it depends. If you have congenital heart disease and are thinking about becoming pregnant, or if you already are pregnant, you need to speak with a high-risk obstetrician (maternal fetal medicine (MFM) specialist) and a cardiologist who has expertise in adult congenital heart disease (ACHD).

There, you’ll learn more about your particular heart defect and how your heart will tolerate pregnancy. This is important information to learn because pregnancy places extra demands on the heart – even if you don’t have congenital heart disease. During pregnancy, normal physiologic changes occur that affect your blood volume, cardiac output, heart rate, and blood pressure.

How pregnancy will affect a woman born with a congenital heart defect depends upon her type of defect, the types of repairs she has or hasn’t had, the kinds of medications she takes, if she had cardiac symptoms and events prior to pregnancy, and how well her valves and heart muscle are currently working. Some potential issues during pregnancy can include heart rhythm problems, heart failure, blood clots, strokes, high blood pressure, and aortic aneurysms (dilation) and dissection (tear in the wall of the aorta). Cardiovascular disease is a cause of maternal complications during pregnancy and it is important that every woman knows her individual risks, both for herself and her unborn child.

If you were born with a congenital heart defect, you may have received mixed messages about pregnancy. Some women were told they “can’t get pregnant” by their doctors, when they likely meant “you shouldn’t get pregnant.” In other words, it is possible for most women with adult congenital heart disease (ACHD) to conceive, but their pregnancy might not be without complications and risk.

The reality is that most women with ACHD (with a few exceptions) can have a healthy pregnancy, so long as heart health is optimized before pregnancy, and they are appropriately monitored during pregnancy, delivery, and the postpartum period.

You can start the process of learning more about your heart defect and how it might impact pregnancy by scheduling a consultative visit with an ACHD specialist. The best time for this is when you are considering or planning a pregnancy — but if you are already pregnant, you should see a specialist in the first trimester.

Here’s what typically happens during a visit:

1. A complete evaluation of your heart. This will help determine how well you might handle the pregnancy. This evaluation usually includes personal and family history, physical exam, EKG, and echocardiography, as well as a review of your cardiac medication list. Additional tests, such as a stress test, Holter monitor, or cardiac MRI may be recommended as well.
2. A detailed discussion about what you can expect. We will describe the potential complications we think you may encounter. We will determine if you are at low, medium, or high risk or if your risks are essentially the same as the general population. The evaluation will help shape the plan for monitoring your heart health during pregnancy and beyond. If you do not already have a high-risk OB or MFM specialist, we will refer you to one as we collaborate closely with our MFM colleagues in Cincinnati.
3. Pre-pregnancy recommendations. If we are able to evaluate you prior to pregnancy, we can advise you if we think you should have any medications, procedures, or surgeries prior to attempting pregnancy so that you might reduce your risks during pregnancy.
4. A genetics discussion. We can also help you determine your risks for passing on the heart defect to your child. It depends upon the condition, but in general the risk is about 1.5-3% if the father has ACHD and up to 18% if the mother has congenital heart disease. A fetal echocardiogram is typically recommended between 18-24 weeks gestation to check for heart defects in your unborn child.

The main take away here is that if you were born with congenital heart disease and you’re thinking about becoming pregnant, please make sure that you are followed by a cardiologist specializing in ACHD.

While the majority of women can have a healthy pregnancy, the spectrum of ACHD complexities is vast, and a course of action needs to be individualized for each patient.

You may find the following video helpful, which answers some of the most common questions related to ACHD and pregnancy that we receive in clinic.