Heart Disease in Pregnancy

The heart works harder to support a pregnancy -- it’s now “pumping for two.” That can be difficult in people with known heart disease. It can also reveal heart disease that was not previously known. These heart conditions increase the risk of complications during pregnancy.

Congenital Heart Disease
Congenital heart disease refers to heart defects that are present at birth and repaired at an early age but can cause complications in adults. They include repaired holes in the heart (ventricular or atrial septal defect), valve disease, and other conditions that affect the structure and function of the heart. In the past, people with these conditions did not live to adulthood. If they did, they were told to avoid becoming pregnant because of the risks to mom and baby. Fortunately, with modern care, close monitoring, and a team-based approach, it's possible for many adults with congenital heart disease to have a successful, safe pregnancy.

Preexisting Heart Conditions
Preexisting conditions such as an irregular heartbeat (arrhythmias), cardiomyopathy, pulmonary or chronic hypertension, a past heart attack, heart failure, or diseases of the arteries and aorta can cause complications during pregnancy.  

Heart Disease Acquired During Pregnancy
Because of the increase in blood volume during pregnancy, the heart must work harder. This can cause heart disease to develop or reveal heart disease previously not known. Women with obesity and diabetes are also at increased risk for developing heart conditions during pregnancy. Common heart conditions that develop in pregnancy include high blood pressure and irregular heart rhythms.

Symptoms of a Heart Condition
Talk to your doctor if you experience the following symptoms during pregnancy. These symptoms are common in pregnancy and do not mean you have a heart condition. Our team can help determine if you do. If needed, they work with your obstetrician during your pregnancy to manage your care.

• Shortness of breath
• Palpitations
• Chest pain
• Fatigue and weakness
• Rapid irregular heartbeat
• Persistent cough or wheezing
• Swelling in ankles and feet

Nearly 50 providers meet regularly to review individual cases and discuss every facet of care for pregnant people with heart disease. This team approach ensures your team has reviewed your case and is prepared for every possible scenario. Duke’s team of specialists includes:

• Maternal-fetal medicine specialists  
• Cardiologists with special training in treating women with heart disease
• An obstetric anesthesiologist who is a practicing cardiothoracic anesthesiologist certified in heart ultrasound
• Heart surgeons

Perinatal Nurse Navigator
Our perinatal nurse navigator is your first point of contact and helps you manage the complex care you will need. She can answer your questions and makes sure your care is coordinated across all these specialties.

Pre-Conception Personalized Risk Assessment
Before becoming pregnant, you’ll meet with our cardiologist for a personalized risk assessment. They evaluate your current cardiovascular condition, and your medications, and create a plan to improve your medical status before pregnancy to ensure you have a safe, successful pregnancy. If needed and appropriate, they may recommend changes to medications and ensure that your medications are safe to take during pregnancy.

Ongoing Prenatal Monitoring and Care
Once you become pregnant, you’ll meet with the team for ongoing monitoring of your condition. Our perinatal nurse navigator will help coordinate your visits. Working as a team, your doctors keep a close watch on your heart function, your symptoms, and how much blood reaches your vital organs, tissues, and importantly, your placenta and baby. As your pregnancy develops, your doctors develop a personalized plan for your delivery and postpartum recovery.

The Role of the Obstetric Anesthesiologist
Obstetric anesthesiologists play an integral role in important decision-making about ongoing monitoring, the timing of, and the best location for you to deliver your child. Our obstetric anesthesiologists are in the hospital all day every day. Our team also works closely with cardiothoracic anesthesiologists and intensive care anesthesiologists when needed.

Anesthesiologists keep a close watch on the heart via blood pressure monitoring, and imaging via cardiac ultrasounds to identify potential problems during delivery and postpartum. They also monitor for bleeding problems and help prevent blood clots and infection, all while reducing pain via the safe use of epidurals and anesthesia, as needed. They continue to monitor your health during the postpartum period.

Childbirth with Heart Disease Considerations
Delivery with heart disease can require precision specialty care as the heart must work harder to pump blood while the uterus contracts. Most people deliver at the Duke Birthing Center, a regional referral center for complex pregnancy care.

The best approach for delivery is determined and organized in advance by our team so that we are ready for you and your baby when the time comes. Vaginal delivery is an excellent, safe option for most people with heart disease. When cesarean delivery is needed, we offer a full range of gentle cesarean delivery services. While rarely needed, our specialty care includes round-the-clock intensive care, cardiology, and cardiothoracic surgical services. This complex care may be needed by people with very challenging heart disease, or when heart conditions worsen during pregnancy.

Follow-Up Care After Pregnancy
We’ll work with you to optimize your care following delivery as you transition to the postpartum unit. We then help you transition your care to a cardiologist and primary care physician for ongoing follow-up for your heart condition and any pregnancy complications that may arise.

We Work Together as a Team
Our specialists offer all the resources you need to have a safe pregnancy and healthy child in one place. Our care for you starts the moment you consider conceiving and through the postpartum phase. Our monthly conference ensures you receive the best possible care and outcome.

Duke University Hospital Is a SOAP Center of Excellence
This designation, given by the Society for Obstetrical Anesthesia and Perinatology, recognizes demonstrated excellence in obstetrical anesthesia. We’ve held this designation since 2018.

You Receive the Highest-Quality, Complex Care
The Duke Birthing Center is designated a Level III facility by the American College of Obstetrics and Gynecology. This means we are equipped to provide care for the most complex, critically ill pregnant people and fetuses.

Close Collaboration with Adult Congenital Heart Program
Our doctors work closely with people in our adult congenital heart disease program. Only 48 programs -- two are in North Carolina -- are accredited by the Adult Congenital Heart Association, the nation’s leading nonprofit organization working to improve the care of adults with congenital heart disease. Accreditation recognizes our high level of care based on personnel, specialized equipment, services, policies, and procedures. Research shows that people cared for at accredited centers experience better outcomes.

Access to Clinical Trials and Therapies
As a Duke patient, you may be eligible to participate in clinical trials. We study new ways to manage lifestyle changes that reduce your heart disease risk and help you manage your pregnancy. We also have access to therapies that are available to people who are not considered candidates for these treatments elsewhere.

We Are Defining Care Guidelines for Pregnant People with Heart Disease
We are collaborating with peer institutions to develop care guidelines, document delivery plans, and create quality-improvement measurements for perinatal cardiac care. Our goal is to improve the quality of care for all patients in North Carolina and beyond.