Married women with heart disease should consult a doctor for a detailed examination to determine if they can safely conceive. If the condition is unstable, it is advisable to heed the doctor's advice to avoid pregnancy and childbirth, which could exacerbate the burden on the heart.
After becoming pregnant, women with mild heart disease should promptly undergo prenatal check-ups and register with an obstetrician. They should follow the guidance of the obstetrician for proper care during pregnancy. Before 5 months of pregnancy, monthly check-ups are recommended, while after 5 months, weekly check-ups are necessary. Two weeks before the expected delivery date, it is recommended to be admitted to the hospital for delivery, so that the pregnancy period can be smoothly managed under close observation and care from medical staff.
In addition, it is important to ensure sufficient rest and sleep during pregnancy, as well as a diet rich in protein and vitamins. It is important to avoid excessive fatigue and emotional excitement, restrict salt intake to no more than 3 grams per day, and actively prevent respiratory and other infections. If any abnormalities are detected, timely hospital examinations are necessary.
How much burden does pregnancy add to the heart? Normally, a healthy heart ejects 60-70 milliliters of blood per beat, with a heart rate of 60-100 beats per minute. Starting from the 10th to 12th week of pregnancy, the cardiac output needs to increase, reaching a 30-40% increase at 24 weeks of pregnancy. By full-term pregnancy, the heart rate increases by about 10 beats per minute, and the total blood volume increases by 30-50% (normal blood volume accounts for 8% of body weight) due to blood dilution. This leads to physiological anemia, along with the enlargement of the uterus, rising intestines, compression of the lower lungs, and increased right ventricular pressure, all of which significantly increase the burden on the heart. Therefore, pregnancy is unfavorable for both the mother and the baby in the case of women with heart disease.
During childbirth, in addition to uterine contractions, the abdominal and skeletal muscles also contract. The mother holds her breath, leading to increased pulmonary circulation pressure and increased intra-abdominal pressure, causing blood to flow towards the heart and increasing energy and oxygen consumption, further burdening the heart. After the fetus is delivered, the uterus quickly shrinks, intra-abdominal pressure decreases, blood rushes to the visceral blood vessels, and at the same time, with the interruption of placental blood flow, a large amount of blood from the uterus enters the circulation, resulting in a sudden increase in venous return to the heart. These factors can contribute to heart failure. Pregnant women with mitral stenosis are prone to acute pulmonary edema during this period. Women with congenital heart disease may experience cyanosis during the second stage of labor due to increased pulmonary circulation pressure while holding their breath.
During the postpartum period, in the first 24-48 hours, due to uterine involution and a large amount of blood entering the circulation, blood volume temporarily increases until it returns to the pre-pregnancy level after 4-6 weeks.
Although heart disease does not affect conception and does not increase the risk of miscarriage, if the burden on the heart is increased during pregnancy, leading to heart failure and tissue hypoxia, it can cause uterine contractions and premature birth. It can also endanger the life of the fetus due to hypoxia.
Under what circumstances can women with heart disease conceive? Generally, women under 35 years old who can engage in daily activities and perform light physical labor can conceive and give birth under the guidance of a specialist. If the age exceeds 35, the heart is significantly enlarged, and mild activity causes palpitations, shortness of breath, and cyanosis of the lips; or if there is rheumatic heart disease with atrial fibrillation, or recurrent heart failure, the risk to both the mother and the baby will increase if pregnant, so contraceptive measures should be taken. If pregnancy occurs, early artificial abortion should be considered, and hospitalization may be necessary if needed.
