Congenital Heart Disease
Women who have congenital heart disease are born with a defect in the structure of the heart or the large blood vessels that carry blood to and from the heart. In general, most women with a congenital heart defect (especially those who've had corrective surgery) can look forward to having children. However, the outcome of pregnancy can be affected by many factors including the type of heart defect, the severity of symptoms, the presence of high blood pressure in the lungs (pulmonary hypertension), and the type of prior surgery and any remaining heart or lung disease. All risk factors must be carefully weighed for a woman with congenital heart disease who is considering pregnancy; each case must be individually evaluated.

If you have congenital heart disease, you should have a full evaluation by a pediatric cardiologist or internal medicine cardiologist who is very familiar with your condition. It's important to determine the nature and severity of your heart defect before becoming pregnant. Usually this will include a physical examination, electrocardiogram (ECG), chest X-rays, an echocardiogram and possibly other tests such as an exercise test. Before you have these tests, tell your doctor if there's any chance that you're already pregnant. After a full evaluation, your cardiologist can advise you of the risk that you and your baby might encounter during and after the pregnancy. If you have a correctable defect, you might be advised to have surgery before becoming pregnant.

Pregnancy isn't advised if there's very high blood pressure in the lung blood vessels (pulmonary hypertension). There's a high risk of maternal death. Other heart defects that carry a high risk of maternal and/or fetal death during pregnancy include:

• severe unoperated aortic valve stenosis (a narrowed valve that prevents blood from being pumped out of the heart into the aorta),
• severe unoperated coarctation of the aorta (a narrowed area in the aorta that prevents blood from flowing from the upper body to the lower body), and
• cyanotic heart defects (unrepaired defects that cause blueness).

If you have congenital heart disease, once you become pregnant you'll require careful attention from a team of physicians skilled in prenatal care, including cardiologists and obstetricians. This attention, with more frequent visits and often more frequent diagnostic testing, is designed to decrease the risks to you and your baby during pregnancy. With this kind of management, most women with congenital heart disease can expect to safely deliver a healthy baby. You may be asked to deliver your baby at a hospital that specializes in complex pregnancy and newborn care.

Rheumatic Heart Disease
Rheumatic fever results from a streptococcal infection. The effects of rheumatic fever in some cases cause lasting damage to one or more of the heart valves (rheumatic heart disease). This damage might not be apparent for several years. Later, however, the inflammation of the heart valves that occurred during the earlier illness produces scarring. This scarring prevents the valves from opening or closing properly, and the normal flow of blood through the heart is hindered. When there's additional strain on the heart, such as during pregnancy, special medical care is necessary.

Prosthetic Heart Valves
If you have an artificial (prosthetic) heart valve, you and your baby have an increased risk during pregnancy. Discuss these risks with your doctor before you become pregnant. If you have a mechanical valve (made of metal or plastic with a moving ball or disc), and it's necessary for you to take blood-thinning medicine such as Coumadin or Dicumarol to prevent blood clots from forming on the valve, this medicine can cause damage to your baby. Before you become pregnant, your physician may want to change your medicine to one called heparin. Heparin doesn't affect the baby and works well as a blood-thinning medicine. It's given by injection. You or your family may have to learn how to give it twice a day.

If you have a non-mechanical or tissue valve, blood-thinning medicines usually aren't required. However, as with mechanical valves, a regular follow-up by your doctor during the pregnancy is necessary.

Marfan Syndrome
The Marfan syndrome is an inherited disorder of connective tissue that can affect many parts of the body, including the heart. The degree of heart involvement varies in this condition. Many doctors feel that if you have the Marfan syndrome with a dilated aortic root, you should avoid pregnancy. The reason is that the aortic root could rupture during the stress of labor, posing a high risk to both you and your baby. Any woman with the Marfan syndrome who does become pregnant should be watched closely by her cardiologist.

Other Conditions
If you have high blood pressure, certain kinds of irregular heartbeats, cardiomyopathy (a dilated heart) or other cardiac ailments, your risk of developing heart problems during pregnancy is greater than that of a woman with no heart disease. Also, some medications used to treat these disorders can affect your baby. If you are pregnant or are planning a pregnancy you should not take ACE inhibitors or ARB’s. Consult your doctor about your own and your baby's care during pregnancy.