Heart Failure During Pregnancy

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Cardiac diseases are a common cause of death and complications during pregnancy. Owing to physical changes that take place during pregnancy, as well as increased levels of emotional and psychological stress, pregnancy can cause existing heart conditions to worsen or can cause new heart conditions to develop.

Heart failure, sometimes referred to as “congestive heart failure,” happens when your heart doesn’t pump as well as it should. It may be caused by coronary artery disease (narrowing of the blood vessels leading to your heart) or high blood pressure or other conditions. But, regardless of the cause, heart failure ultimately leads to a heart that is too weak or stiff to pump all the blood your body needs.

Heart failure in pregnancy

In pregnancy, heart failure can cause maternal and fetal complications, including death. Heart failure can lead to preterm labor and delivery, intensive care unit admission, respiratory failure, arrhythmias, and death in mothers. It can also cause prematurity, small-for-gestational-age status, and infant respiratory distress syndrome, and fetal and neonatal death.

The most common cause of pregnancy-related heart failure is cardiomyopathy. Other risk factors for heart failure during pregnancy include advanced age at conception, pre-existing cardiovascular disease, multifetal pregnancy, and being a survivor of childhood cancer.

If you have already been diagnosed with heart failure before pregnancy, talk to your doctor before you conceive, or as soon as you find out you are pregnant, to understand the risks associated with pregnancy and learn what you can do to keep yourself and your baby healthy.

Symptoms of heart failure

Heart failure may cause:

  • Shortness of breath, especially after exertion and when lying down
  • Fatigue and weakness
  • Swelling of the legs, ankles, and feet and/or the abdomen due to fluid retention
  • Fast or irregular heartbeat
  • Persistent cough or wheezing
  • Increased need to urinate at night
  • Lack of appetite
  • Nausea
  • Difficulty concentrating or staying alert

There are many possible causes to these symptoms, and many of them may be normal, pregnancy-related changes, but if the symptoms are sudden or severe or unusual for you, tell your doctor so he or she can rule out serious causes.

Seek medical help immediately if you experience the following symptoms:

  • Chest pain
  • Fainting
  • Severe weakness
  • Rapid or irregular heartbeat with shortness of breath or chest pain
  • Severe shortness of breath with coughing up pink, foamy mucus

Treating heart failure

Lifestyle changes are important in the management of heart failure: exercise, consume less salt, manage stress, and lose weight. Some of the damage to your heart may not be fully reversible, but improving the symptoms of heart failure can improve your quality of life.

During pregnancy, stabilizing the heart failure is key to its management. There is no specific treatment that is appropriate for pregnant heart failure patients. The goal of treatment during pregnancy is to improve symptoms, prevent heart failure from worsening, and increase the odds of both mother and baby surviving. Supplemental oxygen may be administered as part of this care, and medications to reduce the amount of work the heart needs to do may be considered, depending on the gestational age of the fetus and the overall health of the mother.

The best way to prevent heart failure is to keep your heart healthy. If you have been diagnosed with conditions such as coronary artery disease, high blood pressure, or diabetes, manage these conditions and try to keep them from getting worse.

Jennifer Gibson
Dr. Jennifer Gibson earned a Bachelor of Science degree in Biochemistry from Clemson University and a Doctor of Pharmacy degree from the Medical College of Virginia School of Pharmacy at Virginia Commonwealth University. She trained as a hospital pharmacist and is the author of clinical textbooks, peer-reviewed journal articles, and continuing education programs for the medical community, as well as a contributor to award-winning healthcare blogs and websites. In her free time, she enjoys running, reading, traveling, and spending time with her family.

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