Guest Post: Pregnancy puts stress on the heart—and it doesn’t stop at delivery by Dr. Catherine Weinberg

Experiencing a pregnancy means experiencing a change in your heart.

Dr. Catherine Weinberg, Director of High-Risk Cardiovascular Obstetrics, Cardiology at Lenox Hill Hospital

Yes, it’s going to expand with anticipation and love about the adventure that awaits. Pregnancy can also put your heart at risk for physical complications. Cardiovascular disease is one of the leading causes of pregnancy complications, some of which can lead to lifelong heart concerns. That’s why it’s absolutely critical to understand the cardiac risks of pregnancy and prioritize your heart health throughout the journey from conception to parenthood.

The human heart has to work exceptionally hard during pregnancy, labor, delivery and the postpartum period. It’s responsible for the extra blood — up to 50% more than usual — required to support reproductive organs. The extra work means a woman’s resting heart rate typically climbs. Labor and delivery, especially during the act of pushing with sudden blood pressure fluctuations, can also cause strain on the heart.

While many women’s hearts accommodate these changes and return to pre-pregnancy cardiovascular health within months of delivering, others experience more issues. Pregnancy can exacerbate underlying heart conditions, reveal previously undiagnosed ones, or lead to complications, including high blood pressure, preeclampsia, gestational diabetes, a weakened heart (otherwise known as cardiomyopathy) and irregular heartbeats (called arrhythmias).

These conditions can affect the outcome of pregnancy and delivery in many different ways. High blood pressure can lead to preterm births, while gestational diabetes can lead to preterm births and large babies, with both conditions making pregnancy more difficult. Pregnancy can raise your risk of developing arrhythmia, blood clots, aortic tears, cardiomyopathy, or myocardial ischemia, which is when your heart doesn’t receive enough blood. These can come on during or in the year following your pregnancy and can be either life-threatening or become chronic issues that require lifelong treatment.

While certainly a lot to take in, I’m grateful to report that our understanding of the heart and its impact on pregnancy has grown over the past few decades. Now, I can share some tips with all of my patients to help ensure the greatest outcomes for everyone involved. If you’re thinking about becoming pregnant or looking forward to welcoming a little one soon, keep these guidelines in mind:

  • Meet with your doctor before you conceive. Sometimes, pregnancy can unearth undiagnosed, underlying conditions — or exacerbate issues you didn’t realize were serious. Check in with your OB/GYN, primary care provider, or cardiologist before trying to conceive. This is essential if you know you have an underlying heart condition and especially beneficial if you are older than 35, looking to undergo assisted fertility treatment, or have a family history of cardiovascular disease or high blood pressure. Your doctor will be able to let you know if you should see a cardio-obstetrics specialist for further cardiovascular testing —such as an echocardiogram, stress test or MRI — and give you great overall tips to boost cardiovascular health as you try to have a baby. Catching cardiac concerns before conception and working together to create a testing plan and interventions is key to a healthy pregnancy.
  • Be good to your heart. Even if you’re ready to conceive and are feeling in great health during pregnancy, it’s always critical to keep your heart health in mind. Engaging in pregnancy-safe exercise and sticking to a heart-healthy diet (one high in fiber, fruits and veggies and low in saturated fats) are great ways to strengthen your cardiovascular health and help you feel like the best version of yourself as you try to conceive, as well as once you become pregnant.
  • Know the warning signs. Pregnancy is full of changes, both big and small, to your body. And while many are simply inconvenient and uncomfortable, it’s important to watch out for the ones that could be messages from your body that something more serious is going on. If you experience any of these symptoms during pregnancy or the postpartum period, get in touch with your provider right away:
  • Chest pain or pressure, as if someone is sitting on your chest
  • Fainting or passing out
  • Sudden or severe swelling of your legs: Pregnancy often causes gradual swelling in the extremities, but if it comes on suddenly and intensely, it could be a sign of high blood pressure, preeclampsia or cardiomyopathy.
  • Sudden heart palpitations, high resting heart rate or shortness of breath: Some light, occasional heart palpitations, more shortness of breath than you usually feel or your resting heart rate rising 10-15 points throughout your pregnancy are normal. But if all of a sudden, you experience rapid palpitations or extreme shortness of breath — especially if you’re inactive or it doesn’t go down when you take a few minutes to rest — it could be a sign of too much stress on your heart.
  • New headache: Headaches can be common throughout pregnancy. But if you have one that comes on suddenly and feels different than others, includes spotty vision or doesn’t go away with over-the-counter pain medicine, it could be an early sign of high blood pressure or preeclampsia.
  • High blood pressure: If your blood pressure reading is 140/90, talk to your doctor to discuss frequent monitoring and a plan to treat it. If it’s 160/110, especially in the third trimester or postpartum, seek medical attention immediately.
  • Trust your gut. You may have a symptom that doesn’t seem quite as extreme as the ones above but still feel that something might not be right. Trust your instincts. Call your provider. If they wave it off, but you’re still convinced something is wrong, don’t be afraid to talk to another provider who will listen to your concerns.
  • Take care of yourself: Cardiovascular issues don’t always stop upon delivery. One-third of pregnancy-related deaths happen up to one year after giving birth. Postpartum can be a learning period—and no one is better equipped to care for your baby than you are. In order to provide that care, it’s important to prioritize your own health and well-being too. It’s not selfish to attend to your own needs — it’s selfless to do everything you need to do to stay healthy so you can provide for your child. Continue to be on the lookout for cardiovascular warning signs, prioritize rest and an exercise routine that helps you feel your best and always talk to your provider if you feel like something is off.

I like telling my patients to apply the same five simple lessons they’ll teach their new little ones to themselves: Go to bed on time, go outside and play, eat your vegetables, don’t smoke and give somebody a hug goodnight. They’re the first rules we learn for a reason: They’re the ones that keep our hearts healthy and full of the love we need to be great parents and providers.