How to take care of your heart during pregnancy

The physiological changes that take place during pregnancy are often awe-inspiring, and likely overwhelming for expectant mothers. The growing fetus impacts every single organ—including your heart. It experiences some extreme changes during pregnancy, from a 50% increase in the body’s blood volume to an increased pregnancy heart rate. Your heart is a key to optimal health during pregnancy and every other season of life, too. Here’s how to take care of it.

Heart disease: The leading cause of maternal death

“The leading cause of death in pregnant women and women in the postpartum period is cardiovascular disease,” says Janna Mudd, MD, an OB-GYN practicing at Hoffman and Associates in Baltimore, Maryland. Heart disease contributes to 26.5% of maternal deaths, according to The American College of Obstetricians and Gynecologists. While pre-existing heart conditions are a risk factor, the most common concern is the acquired heart conditions that sometimes develop silently.

A healthy heart pre-pregnancy 

The key to heart health during pregnancy is ensuring a healthy heart prior to getting pregnant, explains Dr. Mudd. This recommendation is in line with The American Heart Association, which advises that women should optimize their heart health before conceiving. 

Mark P. Trolice, MD, a director at Fertility CARE: The IVF Center, suggests exercise and aerobic activity prior to pregnancy and during to ensure a healthy heart. “Regular exercise improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, blood pressure problems, and C-sections—and enhances psychological well-being,” he says. To maintain a healthy heart preconception, it’s important to:

• Reach and maintain a healthy weight
• Stop unhealthy substances (tobacco, alcohol, marijuana, illegal drugs, and prescription drugs taken for a nonmedical reason)
• Eat a healthy diet
• Manage chronic health conditions

If you feel your heart racing during pregnancy it’s probably because your resting heart rate can increase up to 20 beats per minute. In fact, it’s often one of the early signs of pregnancy. Heart rates below 60 BPM may be cause for concern, unless you are very athletic. A healthy heart must be a priority for the health of both mother and baby during pregnancy, and after the baby is born, too.

How to lower a high heart rate during pregnancy

In the past, healthcare providers used to recommend keeping your heart rate below 140 during pregnancy—even when exercising. Today, those limits aren’t typically used. In general, you don’t need to measure or monitor your heart rate during pregnancy. That can be done during prenatal visits. If your provider notices that your heart rate increases more than 20 beats per minute over your pre-pregnancy heart rate, your physician may want you to take steps to bring it down by:

• Exercising regularly, with low impact activities like swimming or walking
• Eating a healthy diet of fruit, vegetables, and lean protein adding up to 2,200 to 2,900 calories a day—that includes limiting caffeine
• Getting regular prenatal care to make sure no health issues are missed
• Using relaxation techniques and meditation to manage stress 
• Seeking treatment for anxiety or depression

If your heart rate increases, don’t hesitate to talk to your provider for help.

Pregnancy and pre-existing heart conditions 

What if you already have a pre-existing heart condition prior to getting pregnant?

“There are certain heart conditions, such as cardiomyopathy, in which pregnancy is not advised due to the risk of morbidity and mortality in the mother,” Dr. Mudd explains. “Other conditions such as high blood pressure and diabetes, which have a higher risk of heart disease, should be optimized prior to pregnancy.” She also advises that women with pre-existing heart conditions consult with their primary care provider, obstetrician and cardiologist pre-pregnancy. You will require important heart-monitoring tests prior and during pregnancy.

Dr. Trolice says that if a woman has significant heart or lung disease, severe high blood pressure, or preeclampsia, then high-impact exercise is not recommended. Low-impact activities such as walking and stretching would still be safe and beneficial. Further, women with abnormal heart rhythms (arrhythmia), poorly controlled diseases like diabetes or high blood pressure, or are extremely under or overweight should discuss the risks with their provider before considering pregnancy, he explains. It is also important to get thyroid levels checked and optimized as needed. 

Heart palpitations during pregnancy: A common complaint 

This symptom isn’t necessarily cause for concern. Heart palpitations during pregnancy are common, occurring in 60% of pregnant women. Dr. Mudd says: “Palpitations are an unpleasant sensation of the forceful, rapid or irregular beating of the heart. They may feel like fluttering or pounding in the chest.” She explains that as long as they are infrequent and short-lived, heart palpitations are not a problem, but if a patient is concerned or worried, they should always consult with their obstetrician.

There are a few reasons why pregnant women might experience heart palpitations, including anxiety, the consumption of caffeine or drugs, heart problems like arrhythmia, or other underlying heart conditions. If you experience chest pain, shortness of breath, or the palpitations are frequent or prolonged, you should seek medical attention, advises Dr. Mudd.

How to stop heart palpitations during pregnancy

In most cases, heart palpitations will go away on their own without treatment. Palpations may resolve with lifestyle techniques such as deep breathing, meditation, and mindfulness. Unless they are due to a more serious underlying condition, it’s likely your healthcare provider will not recommend treatment. In certain circumstances medication will be necessary after your first trimester. In more severe cases, a procedure called cardioversion can shock your heart back into rhythm. Work with your physician to determine the lowest risk to you and your pregnancy.

RELATED: 13 signs of heart problems worth worrying about

This type of heart failure is extremely rare. In the United States, about 1,000 to 1,300 pregnant women will develop PPCM. According to the AHA, some symptoms include fatigue, heart racing or feeling like it’s skipping beats (palpitations), shortness of breath with activity and when laying down, increased need to urinate at night, swelling of ankles and neck veins, and low blood pressure. While PPCM is considered rare, the American College of Obstetricians and Gynecologists says peripartum cardiomyopathy is the leading cause of maternal deaths, and contributes to 23% of maternal deaths in the late postpartum period.

Both Dr. Mudd and Dr. Trolice agree that optimal heart health during pregnancy is important for a healthy overall pregnancy.