Heart health when planning for pregnancy

Pregnancy can put extra stress on the cardiovascular (the heart, blood and blood vessels) system, which can cause complications if you have a pre-existing heart condition and make the pregnancy high-risk. Our pre-conception heart check is designed to manage high-risk pregnancies, aiming to identify the risk or presence of a heart condition before conception for a safer pregnancy.

What is a high-risk pregnancy?

A high-risk pregnancy involves increased health risks to the mother and sometimes the foetus.

A high-risk cardiac pregnancy can be caused by congenital factors (conditions you are born with), conditions that developed during your life, conditions which develop during pregnancy, or even after a previous pregnancy.

For example, a mother may be more at risk of developing pre-eclampsia (high blood pressure) or further heart problems during pregnancy. For the foetus it can be associated with growth restriction and is linked to a slightly increased risk of having a heart problem.

These risks can be compounded by older maternal age, having a twin pregnancy, being overweight, having high blood pressure or any other medical condition.

Heart problems can increase the chance of a high-risk pregnancy

During pregnancy, blood volume increases by up to 50% to aid the development of the foetus, so the heart must work harder to pump blood throughout the body.

1% of pregnant patients in the UK have heart disease and women with congenital heart disease are at slightly more risk of having babies with heart defects. Other heart-related pregnancy risks include premature birth, small birthweight and arrythmias (irregular heartbeat).

Knowing whether you have a pre-existing heart problem allows us to determine if your pregnancy will be high risk, so that we can best manage it for a safer delivery.

However, some women aren’t aware they have a heart problem until symptoms arise during or after pregnancy, that’s why it’s so important to identify risks beforehand.

We’ve designed our pre-conception heart check for this very reason. Dr Isma Rafiq, consultant cardiologist with maternal cardiology expertise at Royal Brompton Hospital, explains: “We aim to provide support for the pregnancy, but particularly for patients who might be at risk of developing heart problems”.

When should you get your heart checked?

If you have been diagnosed with a heart condition, we recommend you book a pre-conception heart check, so that any pre-existing symptoms can be monitored during your pregnancy.

However, if you’ve never had a heart screening, there are factors that may indicate you could be at higher risk. We therefore work with patients who present with the following risks:

• a history, or family history, of cardiac disease (ie congenital heart disease, hypertension, valve disease, cardiomyopathy, arrythmias, etc)
• metabolic disease, such as diabetes
• obesity or poor nutrition
• a history of malignancy, as chemotherapy can affect the heart
• a history of preeclampsia
• an increased risk of pregnancy because of the woman’s age

Planning for pregnancy: Our pre-conception heart check

A high-risk pregnancy doesn’t necessarily mean you’ll have complications during pregnancy. It just means we should monitor your heart health more closely to avoid, manage or treat complications that could arise.

Dr Rafiq says, “Our pre-conception heart check is aimed at women who have a family history of heart problems, or who are at a higher risk of developing heart problems.”

Our goal is to identify risks and manage symptoms before you become pregnant, so that we can achieve the healthiest possible outcome – both during pregnancy and even after your baby is born.

We will consider your past and present medical state to create a personalised plan. While we treat each of our patients as individuals, there are tests we commonly perform on each patient who comes to us. For example:

• echocardiogram – An echocardiogram (echo) is a type of ultrasound scan which looks at the heart and blood vessels. The test uses soundwaves to produce images of your heart
• electrocardiogram – An electrocardiogram (ECG) is a common test used to detect your heart’s rhythm and electrical activity

Professor Li, our consultant cardiologist at Royal Brompton Hospital, explains: “When you refer to us, we can request an echo or ECG test immediately to rule out any concerns and provide reassurance, or identify any underlying conditions so that we can investigate further and create a care plan. Echos and ECGs are common and safe diagnostic methods to use in pregnancy, as they don’t rely on radiation or chemicals”.

Professor Mark Johnson, one of our partner consultant obstetricians, expands, “If any further tests are needed, we can work with our multi-disciplinary team of cardio-obstetricians to ensure each patient receives the specific care they need.”

Adding to this, Professor Michael Gatzoulis, consultant cardiologist at Royal Brompton Hospital says: “We have built, over the past 25 years, the largest pregnancy and heart disease service in the country, caring for patients with complex or simple heart defects. It is best to arrive to pregnancy in the best possible condition”.

Managing pregnancy onwards

While uncommon, conditions like peripartum cardiomyopathy (a type of heart failure which occurs during the last month of pregnancy, or up to five months after giving birth) can arise, especially in women over the age of 30.

That’s why it’s so important for us to monitor a pregnancy from start to finish. We can run diagnostics to specifically monitor and care for the heart and consult with other experts at our hospital to provide an individualised catalogue of care, whether you are at the beginning or the end of your pregnancy.