May 22, 2025 Pregnancy and Your Heart

Natural bodily changes can boost cardiac risks. Here’s what to do about it.

During pregnancy, it’s natural and important to focus on your baby’s health, but it’s just as important to focus on your own health. Complications that can arise as your baby develops don’t just affect your well-being while pregnant. They can also have long-term effects that may boost future risks of developing serious conditions, especially heart disease.

“Pregnancy can be seen as a stress test on a woman’s heart and circulatory system,” says Kimberly Skelding, MD, Division Chief of Cardiovascular Services at Jersey City Medical Center and a member of RWJBarnabas Health Medical Group. “Significant changes occur in the body that put extra strain on the heart. Most moms won’t have any problems, but even some healthy women can experience heart problems or complications related to pregnancy that increase cardiac risks down the road.”

What Raises Risks

A number of impressive changes occur to the body during pregnancy. For example, the blood volume of a pregnant female can increase by almost 30 to 50 percent over baseline levels. To accommodate the added volume, the size and structure of blood vessels increase in both the placenta and mother. Heart rate can increase by almost 20 beats a minute. Pregnancy also boosts the blood’s propensity to clot, which protects against significant bleeding after delivery. These changes will usually normalize once the baby is delivered. Most women can adapt to these pregnancy changes without significant consequences, whereas in other women, these changes may exacerbate an existing condition or trigger development of a new cardiac condition. This can lead to serious cardiac complications not only during pregnancy but in the time after delivery.

Peripartum cardiomyopathy, or a weakening of the heart muscle that can lead to heart failure, is one of the most dreaded cardiac complications of pregnancy. Risk factors include having an age over 35, a history of hypertension (high blood pressure), gestational diabetes and multi-fetus pregnancies.

“It’s important to recognize when a woman is experiencing symptoms such as shortness of breath, fatigue, difficulty walking or lower extremity swelling that may seem out of proportion to what would be expected of a ‘normal’ pregnancy,” says Eman Rashed, MD, PhD, cardiologist, Advanced Heart Failure Treatment and Transplant, at Newark Beth Israel Medical Center and a member of RWJBarnabas Health Medical Group. “Talk to your doctor immediately if you have any concerns.”

Another complication is preeclampsia, a form of hypertension (high blood pressure) that often develops in the second half of pregnancy or after birth. Preeclampsia is marked by elevated blood pressure along with high levels of protein in urine and impaired function of small blood vessels throughout the body. Untreated, it can harm the baby and lead to serious, even life-threatening, organ malfunctions in the mother.

Another common complication is gestational diabetes, a condition in which hormonal changes elevate blood glucose (sugar). High blood sugar often dissipates after childbirth, but having gestational diabetes boosts your risks of later having Type 2 diabetes and heart disease.

Gestational diabetes and preeclampsia, along with other types of hypertensive disorders during pregnancy, are on the rise. Later cardiovascular conditions that are strongly linked to these complications include hypertension, heart attack, heart failure, stroke and peripheral vascular disease. Risks are especially high for non-Hispanic Black women. Heart problems are a bigger concern than many women realize.

“Heart disease kills more women than all cancers combined,” says Rachana A. Kulkarni, MD, Regional Director of Cardiovascular Services for RWJBarnabas Health (RWJBH), Director of the RWJBH Women’s Heart Center and a member of RWJBarnabas Health Medical Group. “What’s more, women with heart trouble have worse short-term and long-term outcomes than men.”

Women often delay seeking care for cardiac symptoms, which can manifest differently than in men, and doctors can sometimes be slower to test and diagnose women. Any delays can result in more heart muscle damage.

How To Stay Healthier

Certain factors that contribute to complications during pregnancy can’t be controlled. For example, women are more prone to develop problems such as preeclampsia and gestational diabetes with age.

But many risk factors and conditions can be modified, treated or controlled through lifestyle changes or medications. Here are some key ways to keep your heart and blood vessels healthy during pregnancy and beyond.

• Take your history into account. Greater awareness of risks is the first step toward minimizing them. Women with preexisting heart disease may experience worsening of their condition and have more severe signs and symptoms during pregnancy, labor, delivery and beyond.
  “Mothers who have preexisting heart disease, hypertension or diabetes in pregnancy are at higher risk of developing hypertension and diabetes following their pregnancy and should be managing those conditions during pregnancy,” says Julie Master, DO, FACC, Medical Director of Noninvasive Cardiology at Monmouth Medical Center and a member of RWJBarnabas Health Medical Group. “It’s also important to discuss with your obstetrical team if you had any complications during a previous pregnancy.”
• Be alert to signs of trouble. Changes in body function are normal during pregnancy, but let your doctor know right away if you experience any symptoms associated with cardiovascular problems, especially if symptoms are severe. Red flags include sudden swelling of feet, hands, ankles or arms; lightheadedness or fainting; unusual fatigue; chest pain; extremely fast heart rate; shortness of breath; persistent coughing; an increased need to urinate at night; or sleep difficulties.
• Practice healthy habits. Abstaining from alcohol and smoking are two important ways to reduce risks. But in addition to a voiding harms, take positive steps to build better health. Eat a heart-healthy diet rich in vegetables, fruits and whole grains, and nutrients such as protein and healthy fats. Exercise under your doctor’s supervision to help strengthen your heart, improve cholesterol balance, manage blood sugar, control blood pressure and make progress toward any weight-reduction goals. Strive to reduce stress with measures such as physical activity, mindfulness or relaxation techniques, adequate sleep and socializing with other people. Continue practicing these healthy habits after the baby is born.
• Get screened. To assess heart risks, your doctor will take a careful medical history, review your symptoms and perform a physical examination. But you may need further tests to find out how a heart condition is affecting your pregnancy. These might include an echocardiogram, which uses ultrasound to look inside the heart, and/or an EKG (electrocardiogram), which measures electrical activity during your heartbeat.

If your obstetrician recommends you see a cardiologist, be sure to follow up right away, and keep visiting all the specialists on your medical team throughout your pregnancy and postpartum years.

Learn more about Women’s Health Services at RWJBarnabas Health.