• Cardiovascular

    Mayo Clinic Q & A: Heart failure during pregnancy — what you should know

a pregnant African American woman resting and reading in bed

DEAR MAYO CLINIC: I'm in the first trimester of my pregnancy, and I know that heart disease runs in my family. What are the warning signs of heart failure during pregnancy? How can I safely manage or prevent this?

ANSWER: First of all, congratulations on being proactive and voicing your concern for yourself and your baby. There are some specific cardiovascular conditions, such as heart failure, which occur during pregnancy. Symptoms from this can overlap with normal pregnancy symptoms such as swelling of the legs, ankles and feet, and shortness of breath while lying in bed at night on your back and while walking short distances. Unfortunately, it may be difficult to tell if the symptoms are from normal pregnancy or signs of heart failure. If you are concerned about any of these symptoms, especially if they worsen, please discuss them with your healthcare team early on, and they can determine if any testing might be needed.

During pregnancy, we recommend the same things that we would if a woman were not pregnant, which is following all the guidelines to ensure ideal or optimal cardiovascular health. Don't smoke, eat a healthy diet and maintain a healthy weight (which is somewhat different for pregnancy because there is a normal amount of weight gain expected). Getting enough sleep is also important. Seven to eight hours of sleep at night is recommended for ideal heart health. You'll want to make sure that you're getting specific things checked by your healthcare team during pregnancy, including your blood pressure, blood glucose and blood lipids. If treatment is needed, act on it as quickly as possible.

We also get questions about exercise for pregnant women. If you were exercising before getting pregnant, it is usually safe to continue the same level of activity that you had before pregnancy. If you were not exercising before pregnancy and want to start an exercise program, it's important to check in with your healthcare team first. Start small and slow — don't push yourself too quickly.

Heart failure can be challenging to diagnose during pregnancy. We also know that a delay in the diagnosis of heart failure during this time also contributes significantly to the risk of dying from heart failure. Currently, there is no recommended single test to identify heart failure during pregnancy. The diagnosis often requires your healthcare team to assess your symptoms in addition to other clinical signs and consider testing which may include an electrocardiogram (ECG or EKG), blood test, chest X-ray and a heart ultrasound. This is why we are working on a research study that utilizes artificial intelligence to analyze data from an ECG to predict the likelihood of cardiac dysfunction or heart failure. This test is simple, readily available in most clinics, rapid (can be done within 10-30 seconds) and, most importantly, safe for you and your baby. The test provides a prediction that can tell you if a woman is at high risk for heart failure or not.

Based on our preliminary studies, we have evidence showing this test is very effective. If we can demonstrate its usefulness in larger research studies, we believe that this test can lead to a major shift in how we care for pregnant and postpartum women. Demilade Adedinsewo, M.B., Ch.B., Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida