Pre-conception heart check: Planning for a high-risk pregnancy

Supporting mother and baby through a high-risk pregnancy takes a holistic approach, managing health from pre-conception through to post birth. Our pre-conception heart check aims to diagnose the presence or risk of a heart condition so that we may manage it for a safer pregnancy.

Cardiovascular disease and high-risk pregnancies

Due to delayed motherhood, the number of pregnant women with cardiovascular disease is on the rise, with maternal heart disease affecting up to 4% of pregnancies and making them high risk.

Cardiovascular disease is one of the main causes of pregnancy-related mortality, with aortic dissection and cardiomyopathies being some of the main reasons.

Pregnancies at an older age can increase the risk of acquiring heart disease, as well as experiencing perinatal complications, such as gestational diabetes.

Further complications of a high-risk pregnancy due to a heart condition include premature delivery, preeclampsia and increased risk of the fetus inheriting cardiovascular conditions.

High-risk pregnancies of this nature are best managed from the beginning, before conception, to assess the risk of developing heart disease or identify its presence for the safest possible pregnancy throughout.

Our pre-conception heart check aims for a safer pregnancy

Our pre-conception heart check is specifically designed to manage a high-risk pregnancy. Dr Claudia Montanaro, consultant cardiologist with maternal cardiology expertise at Royal Brompton Hospital, explains, “We aim to provide support for the pregnancy, whether we are diagnosing the presence or risk of developing heart disease, or treating it”.

Our high-risk pregnancy clinicians will consider risk factors in a patient’s past and current medical state, regardless of whether they have a diagnosed heart condition or not, and monitor symptoms throughout the pregnancy.

Dr Montanaro continues: “For pregnant women with pre-existing heart conditions, the most common complications are arrhythmias. Having a diagnosed heart condition allows us to help our patients plan their pregnancies and prevent or manage symptoms, but unfortunately, some women aren’t aware they have a heart condition until symptoms arise during or after pregnancy.

When to refer to us

Patients with an underlying heart condition do not always adapt well to the physiological changes during pregnancy and are therefore more prone to developing adverse outcomes such as arrhythmias.

To help us identify patients with undiagnosed heart conditions, there are factors which are indicative of potential cardiovascular problems. Professor Mark Johnson, one of our partner consultant obstetricians, explains: “While our pre-conception heart check is a specialist service, we must consider all medical problems which may arise during and even after pregnancy.”

We therefore encourage referrals to our pre-conception heart check based on 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 a pregnancy: Pre-conception heart check

“If a pregnancy is classified as high risk, it doesn’t automatically mean that something will go wrong. It just means we need to work with the patient more closely to monitor and manage potential risks”, explains Dr Montanaro.

We provide an individualised model of care for each patient but there are specific diagnostics we commonly perform for each patient referred to us.

Professor Wei Li, our adult congenital heart disease and echocardiography specialist at Royal Brompton Hospital explains, “Once the patient is referred to us, we are already aware of the predominant symptom or concern, whether it’s palpitations or breathlessness. We can immediately perform an echo or ECG, which are safe tools for diagnosing underlying heart problems.

“These diagnostic methods can help us rule anything out and provide reassurance or identify any concerns that need to be monitored and managed.”

Following this assessment, any further specialised heart and obstetrics investigations will depend on the patient and their individual needs. We will work with our multi-disciplinary team across our specialist centres to ensure a safe pregnancy and delivery.

Managing risk throughout pregnancy and post birth

Our high-risk pregnancy clinicians aim to support women’s heart health after birth, too. While uncommon, conditions like peripartum cardiomyopathy can arise, especially in women over the age of 30. Patients with this condition may present with fatigue, low blood pressure, shortness of breath and palpitations, so they will be referred to us for further testing.

We can then run diagnostics to specifically monitor and care for the heart and consult with other experts at the hospital to provide an individualised catalogue of care. While we can identify potential risk factors at a pre-conception screening, postpartum cardiomyopathy tends to occur in the last month of pregnancy and up to five months after birth. That is why it’s so important to follow the patient throughout the entire process.

Get in touch

For more information or to book an appointment, please contact our customer care team.