From the Guidelines
A visit to a cardiologist during pregnancy is necessary to manage pre-existing heart conditions, monitor heart function, and develop a safe delivery plan, as pregnancy increases the risk of cardiac complications and affects both maternal and fetal health. Pregnancy puts additional strain on the heart as blood volume increases by about 50% and the heart works harder to support both the mother and the baby 1. Specific reasons for referral to a cardiologist include conditions like congenital heart defects, heart valve disorders, arrhythmias, high blood pressure that's difficult to control, or symptoms such as severe shortness of breath, chest pain, or palpitations.
Key Considerations
- A cardiologist can help manage medications safely during pregnancy, such as adjusting blood pressure medications like methyldopa or labetalol to safer alternatives than ACE inhibitors 1.
- Monitoring heart function through tests like echocardiograms is crucial to assess the heart's ability to handle the increased workload during pregnancy 1.
- A multidisciplinary team that includes cardiologists, obstetricians, and other specialists is essential for achieving optimal outcomes for both mother and baby 1.
- Early cardiac consultation is important because proper management reduces risks of complications for both mother and baby, especially during labor and delivery when the cardiovascular system faces additional challenges 1.
High-Risk Conditions
- Women with pre-existing heart conditions, such as congenital heart defects or heart valve disorders, require close monitoring and management during pregnancy to prevent complications 1.
- Pregnancy-specific heart conditions like peripartum cardiomyopathy can develop in women with no prior history, emphasizing the need for regular cardiac check-ups during pregnancy 1.
- High blood pressure, arrhythmias, and other cardiac conditions can increase the risk of complications during pregnancy, making regular monitoring and management essential 1.
From the Research
Importance of Cardiologist Visit During Pregnancy
- A visit to a cardiologist during pregnancy is necessary due to the significant risk of morbidity and mortality associated with pre-existing cardiac diseases or cardiac diseases that occur during pregnancy for both mother and baby 2.
- Cardiac disease has emerged as a leading cause of maternal death in most high-income countries, and the burden of cardiac disease in pregnancy is likely to be growing due to various factors such as an increase in adult survivors with congenital heart disease embarking on pregnancy 2.
Risk Assessment and Management
- Care of high-risk pregnant women with cardiovascular disease, including those with congenital heart disease (CHD), requires a team approach including specialists in maternal-fetal medicine, adult congenital cardiology, and obstetrical anesthesia 3.
- Pregnant women with heart disease are at risk for serious cardiac complications, and approximately one-half of all serious cardiac events (SCEs) are preventable 4.
- Strategies to prevent serious cardiac complications in this high-risk cohort of women need to be developed, and understanding serious complications and how they can be prevented is important 4.
Diagnostic Tools and Treatment Options
- Echocardiography is a safe and effective diagnostic tool indicated in pregnant women with cardiac symptoms or women with known cardiac disease for appropriate selection of women who require close monitoring of cardiac condition and valvular function 5.
- Echocardiography is able to characterize cardiac structural abnormalities and corresponding hemodynamic changes, identifies heart diseases that are poorly tolerated in pregnancy, and helps select patients who may require a cesarean delivery because of hemodynamic instability 5.
- Symptomatic arrhythmias rarely occur during pregnancy and are predominantly benign, but previous or existing heart diseases can increase the occurrence of arrhythmias, and cardiologists with special expertise in arrhythmias should always be consulted, especially in the case of complex and relevant rhythm disturbances 6.