ConditionHeart & circulation
Maternal Cardiac Complications (Heart Problems in Pregnancy)
Maternal cardiac complications are heart and blood vessel problems that occur during pregnancy, labor or the year after birth. They include peripartum cardiomyopathy, heart attack from coronary artery dissection, dangerous heart rhythms, worsening of pre-existing heart disease, and high blood pressure disorders such as preeclampsia. Cardiovascular conditions are a leading cause of pregnancy-related deaths in the US. Many deaths are preventable when symptoms like breathlessness, chest pain or palpitations are taken seriously and specialist care is planned early.
Also called: Heart complications in pregnancy, cardiac complications of pregnancy, pregnancy-related heart problems, cardio-obstetrics
At a glance
- What it is
- New or worsening heart and vascular problems during pregnancy or up to a year after birth.
- Main conditions
- Peripartum cardiomyopathy, preeclampsia, coronary dissection and heart attack, arrhythmias, valve disease, aortic dissection, blood clots.
- Why pregnancy strains the heart
- Blood volume rises by about 40% to 50% and the heart pumps 30% to 50% more.
- Warning signs
- Breathlessness lying flat, chest pain, fainting, racing or irregular heartbeat, severe swelling.
- Care
- Pre-pregnancy counseling, cardio-obstetric team care, planned delivery, postpartum monitoring.
When to get help
Call 911 or go to the ER
- Chest pain or pressure, especially spreading to the arm, back, neck or jaw
- Severe shortness of breath, or breathlessness that wakes you at night or prevents lying flat
- Fainting or a seizure
- A racing or irregular heartbeat with dizziness, chest pain or breathlessness
- Severe headache with vision changes, or sudden severe tearing chest or back pain
- Coughing up blood, or sudden breathlessness with leg swelling
See a doctor within a day or two
- Blood pressure of 140/90 or higher at home, especially with headache or swelling
- Swelling of the legs that is increasing, or rapid weight gain of more than 2 to 3 lb (about 1 kg) in a day
- New palpitations that come and go
- Breathlessness that is getting worse week by week, beyond what is expected
Book a routine appointment
- Known heart disease and planning a pregnancy, or newly pregnant
- A history of preeclampsia, peripartum cardiomyopathy or heart surgery, for preconception advice
How pregnancy affects the heart
Pregnancy is a major workout for the cardiovascular system:
- blood volume increases by about 40% to 50%
- the heart's output rises by 30% to 50%
- resting heart rate rises by 10 to 20 beats per minute
- blood pressure falls in mid-pregnancy, then returns toward normal
- during labor and immediately after birth, large fluid shifts occur
- blood becomes more prone to clotting
A healthy heart adapts easily. A heart with hidden or known disease may not.
Normal pregnancy causes mild breathlessness, ankle swelling, tiredness and occasional skipped beats, which makes it easy to miss warning signs.
Main maternal cardiac complications
| Condition | Key features | When it typically occurs |
|---|---|---|
| Peripartum cardiomyopathy | Weakened heart muscle, heart failure | Last month of pregnancy to 5 months after birth |
| Preeclampsia and hypertensive disorders | High blood pressure, protein in urine, organ strain | After 20 weeks and up to 6 weeks postpartum |
| Spontaneous coronary artery dissection | Heart attack from a tear in a heart artery, often in women without usual risk factors | Late pregnancy and first weeks postpartum |
| Arrhythmias | Palpitations, dizziness, fainting | Any time |
| Valvular heart disease | Breathlessness, fluid in the lungs, especially with mitral stenosis | Second and third trimesters |
| Pulmonary hypertension | High lung blood pressure; very high risk in pregnancy | Any time |
| Aortic dissection | Sudden tearing chest or back pain; higher risk with Marfan syndrome | Third trimester and postpartum |
| Blood clots and pulmonary embolism | Leg swelling, chest pain, sudden breathlessness | Highest after birth |
| Congenital heart disease | Depends on the defect | Any time |
Who is at higher risk
- pre-existing heart disease, including repaired congenital heart defects
- chronic high blood pressure, diabetes, obesity
- age over 35 to 40
- Black women, who face significantly higher rates of pregnancy-related cardiovascular death in the US, reflecting differences in access, care and structural factors
- multiple pregnancy (twins or more)
- a history of preeclampsia or peripartum cardiomyopathy
- Marfan syndrome and other aortic conditions
- smoking and substance use, including cocaine
- some cancer treatments in the past
Diagnosis
Symptoms that are out of proportion to a normal pregnancy, or that come on suddenly, are investigated:
- blood pressure, oxygen level and heart rate
- ECG
- echocardiogram: ultrasound of the heart, safe in pregnancy
- blood tests: BNP (a heart failure marker), troponin (heart muscle damage)
- Holter monitor for palpitations
- chest X-ray, CT or MRI when needed, with appropriate shielding; necessary imaging should not be withheld because of pregnancy
Treatment and care
- pre-pregnancy counseling: people with known heart disease should see a cardiologist before conceiving to assess risk and adjust medicines, since some (such as ACE inhibitors, ARBs and warfarin in certain doses) are not safe in pregnancy
- a cardio-obstetrics team: obstetricians, cardiologists, anesthesiologists and maternal-fetal medicine specialists plan care together
- medicines safe in pregnancy for blood pressure, heart failure and rhythm problems
- delivery planning: most people with heart disease can have a vaginal birth with epidural pain relief; cesarean is for obstetric reasons or specific heart conditions
- aspirin from 12 weeks for people at high risk of preeclampsia, as advised
- postpartum follow-up: a blood pressure check within 3 to 10 days for those with hypertension, and continued cardiac care, since many complications appear after birth
Long-term heart health
Preeclampsia, gestational diabetes, gestational hypertension and preterm birth are linked to a higher lifetime risk of heart disease and stroke. Share your pregnancy history with your primary care doctor, and keep up blood pressure, cholesterol and blood sugar checks.
Frequently asked questions
What heart problems can occur during pregnancy?
They include peripartum cardiomyopathy, preeclampsia and other high blood pressure disorders, heart attack from coronary artery dissection, arrhythmias, worsening of valve or congenital heart disease, aortic dissection and blood clots in the lungs.
Is shortness of breath normal in pregnancy?
Mild breathlessness with exertion is common, especially later in pregnancy. Breathlessness at rest, when lying flat, waking you at night, or with chest pain, palpitations, coughing or fainting is not normal and needs urgent assessment.
What is peripartum cardiomyopathy?
It is a weakening of the heart muscle that develops in the last month of pregnancy or the months after birth, causing heart failure symptoms such as breathlessness, swelling and fatigue. Many women recover heart function with treatment.
Can you have a healthy pregnancy with heart disease?
Many women with heart disease have successful pregnancies with careful planning and specialist care. The risk depends on the specific condition. Some conditions, such as severe pulmonary hypertension, carry very high risk, so preconception counseling is essential.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Obstetricians and Gynecologists: Practice Bulletin No. 212: Pregnancy and Heart Disease
- American Heart Association: Cardiovascular considerations in caring for pregnant patients (scientific statement)
- CDC: Pregnancy Mortality Surveillance System and Hear Her campaign
- European Society of Cardiology: Guidelines for the management of cardiovascular diseases during pregnancy
- MedlinePlus: Pregnancy and heart disease