For some women, a cardiologist is just as necessary during pregnancy as an obstetrician.  According to the Center for Disease Control Maternal Mortality Surveillance System heart disease is the leading cause of pregnancy-related death. So for women living in Texas, which is among the top 10 states for highest rates of maternal death, and for Black women who have the highest rates of pregnancy complications in the nation, heart care during pregnancy can be lifesaving.

How is the heart affected by pregnancy?

The body adjusts to accommodate an extra life by making more blood. If a woman is pregnant with twins, her body may produce twice as much blood as it normally would. In order to move the blood all the way to the baby and through the rest of the body, the heart has to pump harder and faster. As the pregnancy progresses, the heart works harder and harder.

            “From a cardiac perspective, pregnancy is a 9 month workout on the heart,” said Peter Ermis, MD, medical director of the Adult Congenital Heart Program at Texas Children’s Hospital, which closely partners with the Maternal Heart Program at Texas Children’s. “That’s why you feel like you’ve been running a marathon when you’re in your third trimester, because your heart is already at its max.”

            For most women, these changes will not cause problems, but some will experience heart symptoms such as extreme fatigue, a feeling of racing heart or chest pressure and may benefit from seeing a cardiologist.

What is the cardiologist’s role during pregnancy?

For some women, this strain on the heart reveals conditions such as irregular heartbeats or weak heart muscle that had previously not caused any problems. In this case, a cardiologist is involved to diagnose the heart problem and recommend treatment. The Maternal Heart Program also offers in depth discussion of how a specific heart condition may or may not affect the pregnancy. The physicians at Texas Children’s have years of experience looking at how the heart behaves during pregnancy.

Some women enter pregnancy knowing that they have existing heart conditions, such as elevated blood pressure or problems with the heart valves. In these cases, initiating care before becoming pregnant is a smart move.

            “For all of our patients with cardiac issues or any history of cardiac issues, we recommend that they are seen initially in our preconception clinic,” said Dr. Ermis.

            At a preconception visit through the Maternal Heart Program, a woman has the opportunity to speak with a maternal-fetal medicine specialist, a cardiologist and a genetic counselor at the same visit. The risks of pregnancy, given her specific heart condition, are discussed in detail. A plan can be made ahead of time for any initial testing, such as a cardiac stress test, or additional pregnancy care, like heart imaging, that may help to prevent complications. These interventions can help the pregnancy and delivery go smoothly and provide the expecting parents a greater probability of a full-term delivery.

Knowing your options

While a cardiologist knows the heart and an obstetrician knows pregnancy, it can be harder to find a provider who is comfortable answering questions about the heart and pregnancy combined.

“Sometimes a local institution or provider wants women to deliver early and have a C-section due to their heart issues, but it’s very rare actually that people need to deliver early or have a C-section from a heart perspective. Our goal is to strive for normalcy in that regard,” said Dr. Ermis.

Likewise, it’s very rare that his clinic will recommend against pregnancy. Dr. Ermis reassures his patients with heart disease that, with the right care, they can expect to have normal pregnancies. 

If you or someone you love has an underlying heart condition and is pregnant or considering pregnancy, it’s important to understand all you can about your condition and seek out the care that you need. Dr. Ermis notes that, “the data shows that, for those patients who are African American and have peripartum cardiomyopathy or other conditions, they are underrecognized, undertreated, and outcomes are worse, and so being able to engage experts for any issues related to the heart is essential.”

“Your doctor team should listen to your concerns and respond with expertise and empathy that will allow you and your baby with the best start in life possible,” said Dr. Ermis

To make an appointment or see the doctors at Texas Children’s Maternal Heart Program, call Texas Children’s Pavilion for Women at 832-826-4636.