Heart Disease & Pregnancy: Managing Risks for a Healthy Journey
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Heart disease in pregnancy is the leading cause of death among pregnant women in the U.S., partly because blood volume rises by 40% to 45% and the heart works harder. Congenital heart disease is the most common form. Chest pain, fainting and shortness of breath at rest need immediate care, and some heart medicines must be switched under supervision. [1]
What the research says
Most pregnant women in a large heart disease registry had congenital or valve disease, and outcomes have improved. A European registry followed 5,739 pregnancies in women with heart disease (2007–2018). Overall maternal mortality was 0.6% and highest (9%) in women with pulmonary arterial hypertension, and heart failure occurred in 11%. Despite more high-risk pregnancies, complication rates fell from 13.2% in 2010 to 9.3% in 2017. (Roos-Hesselink et al., Eur Heart J, 2019)
Cardiovascular conditions are among the leading causes of pregnancy-related death in the U.S., and most such deaths are preventable. CDC data for 2011–2015 showed 17.2 pregnancy-related deaths per 100,000 live births. The rate was 42.8 for Black women versus 13.0 for white women (3.3 times higher). About 60% of deaths reviewed by state committees were judged preventable, and about 1 in 3 deaths (33%) occurred between 7 days and 1 year after delivery. (Petersen et al., MMWR, 2019)
How Pregnancy Affects the Heart
Pregnancy changes the cardiovascular system so the growing baby gets enough oxygen and nutrients. These changes are normal, but they put real stress on the heart and blood vessels.
Normal Physiological Changes
These changes can cause fatigue, mild dizziness and occasional palpitations. Because those sensations overlap with symptoms of heart disease, it can be hard to tell normal pregnancy discomfort from a serious problem.
Preexisting Heart Conditions and Pregnancy
Many women start pregnancy with a heart condition they were born with or developed earlier. Risk depends on the specific diagnosis and how well the heart is working now.
Condition Category | Common Examples | Pregnancy Risk |
Congenital heart disease | ASD, VSD, PDA | Generally lower risk if successfully repaired; depends on the individual. |
Complex congenital conditions | Tetralogy of Fallot, Ebstein anomaly | Higher risk; specialist (cardio-obstetrics) care recommended. |
Cardiomyopathy | Dilated cardiomyopathy | High risk; the leading cause of serious complications and death in pregnancy. [1] |
Valve disease | Mitral stenosis, aortic regurgitation | Varies with severity; severe stenosis can be life-threatening. |
When Pregnancy May Be Too Risky
Some conditions, such as severe pulmonary hypertension or Eisenmenger syndrome, can make pregnancy extremely dangerous, and providers may advise avoiding pregnancy. [1] In the European registry, women with pulmonary arterial hypertension had the highest mortality (9%). (Roos-Hesselink et al., 2019)
Heart Conditions That Develop During Pregnancy
Some women with no history of heart problems develop new heart conditions during pregnancy or soon after delivery.
Arrhythmias: Supraventricular tachycardia (SVT) is the most common sustained arrhythmia during pregnancy. [1]
Peripartum cardiomyopathy: A rare form of heart failure that occurs late in pregnancy or in the months after delivery.
Spontaneous coronary artery dissection (SCAD): A tear in a heart artery. About 1 in 3 cases are pregnancy-related. [1]
Blood clots: Deep vein thrombosis and pulmonary embolism are four to five times more common during pregnancy. [1]
Recognizing Warning Signs
Fatigue and swelling are common in pregnancy, but some red flags suggest the heart is struggling.
Symptoms to Report Immediately
Chest pain: Any chest discomfort or pressure. Call emergency services.
Severe shortness of breath: Trouble breathing at rest, or waking up gasping for air at night.
Neurological changes: Fainting, blurred vision or severe confusion.
Rhythm problems: Palpitations that last longer than 30 seconds. [1]
At prenatal visits, your provider will also watch for high blood pressure, protein in the urine, an enlarged heart and new heart murmurs.
When to Seek Emergency Care
Call emergency services for chest pain, fainting or severe shortness of breath. Do not wait for your next appointment, and tell emergency staff that you are pregnant.
Management and Safety
Pregnancy with heart disease needs a multidisciplinary team, usually including an obstetrician and a cardiologist.
Safe Management Strategies
Medication review: Some common heart medicines, such as ACE inhibitors and certain anticoagulants like warfarin, are unsafe for the baby. Your doctor will switch you to safer options. Do not stop any medicine without talking to your provider first. [1]
Heart-healthy lifestyle: Limit sodium, sugar and saturated fat, avoid excess weight gain and manage stress with approved relaxation techniques.
Regular monitoring: Expect frequent check-ups and tests such as echocardiograms to track heart function.
Postpartum care: Complications can happen within six months of giving birth, so continued follow-up is important. [1]
Conclusion
Heart disease adds real challenges to pregnancy, but with early planning and specialized care, most women can have a safe and successful pregnancy. Knowing your risks, recognizing warning signs and working closely with your medical team protects you and your baby.
Looking for clear answers on tough health questions? Browse plain-language health guides at Rinnit.com.
Frequently Asked Questions
Can I have a natural birth if I have heart disease?
Many women with heart conditions can have a vaginal delivery. Your medical team will decide the safest delivery method based on your heart function and your baby's health.
Why is Black maternal health a particular concern with heart disease?
In U.S. data, Black women have a risk of pregnancy-related death about three times that of white women, and cardiovascular conditions are among the leading causes. Cleveland Clinic reports that risk is tripled compared with white or Hispanic women. [1]
Is it safe to take blood thinners while pregnant?
Some anticoagulants, such as warfarin, are unsafe in pregnancy. Your provider can prescribe alternatives that are considered safe if you need a blood thinner. Never stop a medicine without talking to your provider. [1]
Does gestational diabetes affect my heart?
Yes. Cleveland Clinic reports that gestational diabetes raises the risk of cardiovascular disease later in life by 68%. [1]
What is cardiac output?
Cardiac output is the amount of blood your heart pumps each minute. It can increase by 30% to 50% during pregnancy, and by up to 60% with twins. [1]
Can I breastfeed if I have peripartum cardiomyopathy?
It depends on the medicines you take. Discuss your breastfeeding plans with your cardiologist so your medicines are safe for your baby.
What is the most common heart problem in pregnancy?
Congenital heart disease (heart conditions present from birth) is the most common form of cardiovascular disease during pregnancy in the U.S. [1] In a large European registry, 57% of women with heart disease had a congenital condition and 29% had valvular heart disease.
When should I see a cardio-obstetrics specialist?
If you have a heart condition, ideally before you become pregnant, so your risks can be assessed and your health optimized. Providers may also refer you during pregnancy. [1]
Is swelling in the ankles always a heart problem?
No. Mild swelling is common in pregnancy. Sudden or severe swelling, especially with high blood pressure, shortness of breath or protein in the urine, should be checked promptly.
Can stress cause heart problems during pregnancy?
Stress does not directly cause heart disease, but it adds strain to the cardiovascular system. Managing stress is part of a heart-healthy pregnancy.
What is an ectopic heartbeat?
An ectopic heartbeat is an extra heartbeat that can feel like a flutter. It is often harmless, but report it to your provider, especially if palpitations last longer than 30 seconds. [1]
Does preeclampsia increase future heart risks?
Yes. Cleveland Clinic reports that women who have had preeclampsia are 75% more likely to die of cardiovascular disease later in life. [1]
How long should I be monitored after giving birth?
Heart complications can happen up to six months after delivery, and CDC data show pregnancy-related deaths occur well into the postpartum period. Ask your care team for a postpartum follow-up plan. [1]
Can I take over-the-counter cold medicine if I have a heart condition?
Check with your doctor or pharmacist first. Some ingredients can raise blood pressure or interact with heart medicines.
What is Marfan syndrome?
Marfan syndrome is a genetic condition that affects connective tissue and can cause dangerous widening of the aorta, which makes pregnancy higher risk and calls for specialist planning.
References
Cleveland Clinic. Heart Disease & Pregnancy. Cleveland Clinic. Last updated August 4, 2022. https://my.clevelandclinic.org/health/diseases/17068-heart-disease--pregnancy
Roos-Hesselink J, et al. Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC). Eur Heart J. 2019;40(47):3848-3855. PMID 30907409. https://doi.org/10.1093/eurheartj/ehz136
Petersen EE, et al. Vital Signs: Pregnancy-Related Deaths, United States, 2011-2015, and Strategies for Prevention, 13 States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2019;68(18):423-429. PMID 31071074. https://doi.org/10.15585/mmwr.mm6818e1
Medical disclaimer
This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have about a medical condition. Never disregard professional medical advice or delay seeking care because of something you have read here. If you think you may have a medical emergency, call your doctor or emergency services immediately.
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