Even though pregnancy and childbirth stress the heart, most women with a congenital heart defect (CHD) are able to have healthy pregnancies if they choose to do so.
Women with a CHD interested in getting pregnant should see a health care professional who specializes in CHDs before becoming pregnant to determine any risks for complications during pregnancy.
Preconception counseling—as it is called—can identify any heart problems that may need treatment before conception to assess a baby's risk of being born with a CHD.
Consult with a Specialist:
If you have a CHD and are considering becoming pregnant, you should schedule an appointment with a congenital cardiologist. You will need to tell the congenital cardiologist if you have any cardiac symptoms, such as:
Bring a list of all of your medications to a preconception counseling appointment for review. Some medications should not be taken during pregnancy.
Cardiac Testing Prior to Conception:
Your doctor will perform special medical tests to see if your heart can handle the increased demands of pregnancy. At a minimum, you will receive an echocardiogram—a type of ultrasound that allows doctors to see a video of the heart.
Depending on your symptoms and echocardiogram results, your doctor may perform other tests such as:
Holter monitoring: Provides a constant reading of your heartbeat so your doctor can see if you have an unusual heart rhythm.
Exercise test: Shows your doctor how your heart handles stress when it needs to work harder.
Cardiac MRI: Another type of imaging test that can very accurately show heart size and how well the heart is working.
Occasionally, pre-conception test results show that a woman needs a surgery or a catheterization—a nonsurgical way to treat the heart. Catheterization is done by inserting a thin tube into a blood vessel in the neck, arm or leg and threading it to the heart.
Your doctor may recommend performing surgery or catheterization before pregnancy to treat damage to a heart valve, narrowing of a vessel, or an aneurysm.
Determining Risks for Pregnancy Complications:
Your congenital cardiologist will give you a "risk assessment" on your likelihood to have cardiac complications during pregnancy. In some cases, your doctor may say your risk of having a dangerous pregnancy is very high. In this situation, discussions with your doctors can help you and your partner better understand these risks as well as consider other options.
Preconception Counseling with Other Specialists:
Ask your congenital cardiologist for help finding other medical specialists who can help you make decisions about pregnancy and delivery.
Genetic Counselor: Reviews your medical history and may perform testing to determine the baby's risk for having a CHD. In general, a baby whose mother or father has a CHD has a small increased chance (about 5% on average) of being born with a CHD, too.
Anesthesiologist: Can talk to you about anesthesia options for labor and delivery. Most women with a CHD can have an epidural during labor and delivery. Vaginal delivery is usually preferred over a cesarean section for most women with a CHD. There may be some special monitoring and accommodations made during your labor and delivery, but all medical care is geared toward the safety of you and your baby.
Social Worker: Can help counsel you and your partner on how to handle the stress of managing both your cardiac and pregnancy health.
Parenting can be hard. It is important to talk to your congenital cardiologist about how a CHD will affect your health after delivery, too. See Parenting with CHD: Why Prioritizing Your Own Health is Important.
Additional Information from HealthyChildren.org:
Additional information regarding congenital heart defects and lifelong cardiac care is available at the Congenital Heart Public Health Consortium (CHPHC) website, www.chphc.org. The CHPHC is housed at the American Academy of Pediatrics through a grant from the Centers for Disease Control and Prevention in an effort to utilize public health principles to affect change for those whose lives are impacted by a CHD. Organizational members of the Consortium represent the voice of providers, patients, families, clinicians and researchers.