Pregnancy can be a stressful time even without the added worry of heart health.

Most patients are going to want to maintain some level of fitness throughout their pregnancy, but for people with heart conditions who are trying, or may already be pregnant, there are a number of increased risks which they need to discuss with all of their health practitioners.

Throughout pregnancy, the mother’s whole body is under added stress, in particular there are increases to heart rate, blood volume and cardiac output, as well as changes to blood pressure1. Because of these changes, the doctor will perform a number of checks, including blood pressure checks, weight checks and electrocardiograms throughout the pregnancy, but these changes can create additional risk for expectant mothers with pre-existing heart conditions.

There are some heart conditions which may require treatment before trying to conceive, so those with serious cardiovascular problems should consult their doctor first. Patients with artificial valves or congenital heart conditions should generally be referred if they are planning on getting pregnant, as these conditions need extra care.

Heart Medicines in Pregnancy

Many medications may affect the baby during pregnancy, and pharmacists are ideally suited to answer medicine safety questions during pregnancy. While most medications will have benefits which outweigh their risks, there are some medicines for heart conditions which should be avoided or changed before trying to conceive. This is a dialogue which needs to be opened with their regular prescriber, preferably before conception.

Once a woman starts to plan their pregnancy, or discovers that they are pregnant, it is essential to facilitate communication between all their healthcare providers — their family doctor, the doctor overseeing their pregnancy, and any specialists they may see, for example cardiologists. They all need to be in the loop of the pregnancy to ensure a holistic approach to patient care.

It is important to remind patients to regularly see their doctor for all follow-up appointments, and to take their medicines exactly as directed. It also helps to remind them to make sure any over-the-counter or herbal medicines are safe to take during pregnancy, or when breastfeeding.

Diet

Diet plays a big role in heart health, and not just during pregnancy. A diet high in fibre, and fruit and vegetables is often recommended, while avoiding foods with excessive sugar, salt or fat. Caffeine is also not suggested. Some women may want to discuss their diet with a dietician to determine some changes they could make to keep healthy throughout their pregnancy.

Exercise

Barring any contraindications, mild intensity aerobic activity during pregnancy is also important to maintain a healthy heart, with current recommendations of around 10–20 minutes of exercise daily2. It is suggested to keep the intensity low enough that the mother can still maintain conversation while exercising. Suitable exercises include walking, jogging, aquarobics and the numerous pregnancy exercise classes which are available.

References:
1. O’Day, M. (1997). Cardio-respiratory physiological adaptation of pregnancy. Seminars in Perinatology, 21(4):268–275.
2. Better Health Channel. 2014. “Pregnancy and exercise”. State Government of Victoria.