Maternal Cardiovascular Complications in Pregnancy

Maternal Cardiovascular Complications in Pregnancy

Cardiovascular disease (CVD) is now one of the leading indirect causes of maternal death worldwide, including in India.
Pregnancy places a significant strain on the heart and circulatory system — and in women with pre-existing heart disease or new-onset cardiac conditions, it can become life-threatening.

 According to WHO (2024), cardiovascular disorders account for 15–20% of maternal deaths globally, and the rate is rising among younger women due to hypertension, obesity, and delayed pregnancy.

The emerging field of “Cardio-Obstetrics” is now gaining importance — a multidisciplinary approach combining obstetric, cardiology, and anesthetic care for pregnant women at cardiac risk.

 Pregnancy Stresses the Heart

During pregnancy:

• Blood volume increases by 40–50%
• Cardiac output rises by 30–50%
• Heart rate increases by 10–20 beats per minute
• The body experiences hormonal and vascular changes that reduce resistance but increase cardiac workload

These changes are normally well-tolerated by healthy women.
However, in those with underlying cardiac disorders, the heart may fail to adapt, leading to complications.

Major Types of Maternal Cardiovascular Complications

1. Hypertensive Disorders of Pregnancy (HDP)

Includes:

• Gestational hypertension
• Pre-eclampsia / Eclampsia
• Chronic hypertension with superimposed pre-eclampsia

 These are among the most common cardiovascular issues in pregnancy, affecting about 10% of Indian women.

Complications:

• Endothelial dysfunction and vasospasm
• Pulmonary edema
• Stroke or heart failure
• Placental abruption and fetal growth restriction

Pre-eclampsia doubles the long-term risk of maternal heart disease and stroke later in life.

2.  Peripartum Cardiomyopathy 

A unique, pregnancy-specific form of heart failure that occurs:

• In the last month of pregnancy, or
• Within 5 months postpartum

Symptoms:

• Breathlessness, swelling, fatigue, chest pain
• Often mistaken for “normal” pregnancy discomforts — leading to late diagnosis

Risk factors:

• Advanced maternal age (>30)
• Multiple pregnancies
• Hypertension or pre-eclampsia
• Obesity
• Low socioeconomic status

PPCM causes reduced left ventricular function — can be reversible if detected early.

3.  Arrhythmias 

• Pregnancy increases sensitivity to hormonal and electrical changes, which may trigger atrial or ventricular arrhythmias.
• Women with congenital heart disease or previous heart surgery are more vulnerable.

Danger signs: Palpitations, dizziness, fainting, chest pain.
In severe cases → can lead to sudden cardiac arrest during labor.

4.  Aortic Dissection & Marfan Syndrome

• Aortic dissection (tear in the aortic wall) is rare but fatal if untreated.
• Pregnancy hormones weaken the aortic wall, especially in women with Marfan syndrome or connective tissue disorders.
• Typically occurs late in pregnancy or postpartum.

Symptoms: Sudden chest/back pain, breathlessness, or collapse.
Requires immediate surgical intervention.

5.  Pulmonary Hypertension 

• In this condition, pressure in pulmonary arteries is abnormally high.
• Pregnancy greatly worsens the condition due to increased blood flow and oxygen demand.
• Maternal mortality can exceed 30–50% in severe PH cases.

 Women with PH are often advised to avoid pregnancy, and if pregnant, must be managed in tertiary cardiac centers.

6.  Congenital Heart Disease 

• With improved pediatric cardiac care, more girls with congenital heart defects now reach adulthood and become pregnant.
• Common lesions: ASD, VSD, Tetralogy of Fallot (repaired).

Risks during pregnancy:

• Heart failure due to increased volume load
• Arrhythmias
• Fetal growth restriction or preterm delivery

Preconception counseling and risk stratification are essential for these women.

7.  Ischemic Heart Disease 

• Once rare in young women, heart attacks during pregnancy are increasing due to:
  • Sedentary lifestyle
  • Obesity
  • Diabetes
  • Smoking
  • Stress

Pregnancy-related MI (myocardial infarction) is often caused by coronary artery dissection or thrombosis, not typical atherosclerosis.

Most events occur in the third trimester or postpartum, often during delivery.

 Risk Factors in India

Category	Examples / Contributors
Pre-existing Conditions	Hypertension, diabetes, obesity, congenital heart disease
Pregnancy-related Disorders	Pre-eclampsia, gestational hypertension, anemia
Lifestyle Factors	Smoking, poor diet, lack of exercise
Sociodemographic	Late pregnancy (>35 years), short birth intervals
Healthcare Gaps	Lack of cardiac screening, delayed referral, poor awareness

Rural and semi-urban women are at particular risk due to undiagnosed hypertension and limited access to cardiology care.

 These Complications Are Dangerous

• Symptoms overlap with normal pregnancy signs, such as fatigue or swelling → delayed detection.
• Sudden hemodynamic shifts during delivery or postpartum can cause heart failure or collapse.
• Misdiagnosis (as anemia, anxiety, or asthma) is common in under-resourced settings.
• Lack of cardiac monitoring during labor increases fatality risk.

Diagnosis & Monitoring

Essential Tests:

• ECG and Echocardiogram (safe during pregnancy)
• BNP / NT-proBNP for heart failure detection
• Blood pressure & urine protein monitoring
• Oxygen saturation & cardiac output measurement

Fetal Monitoring:

• Regular growth scans and Doppler studies (for uteroplacental circulation).

Prevention & Management Strategies

Before Pregnancy

• Preconception cardiac assessment for women with known heart disease.
• Optimize control of hypertension, diabetes, thyroid, and weight.
• Avoid conception during unstable cardiac periods.

During Pregnancy

• Frequent multidisciplinary follow-up (obstetrician + cardiologist + anesthetist).
• Avoid overuse of IV fluids and salt intake.
• Use of beta-blockers or diuretics when indicated (under supervision).
• Early delivery planning in tertiary care centers with cardiac monitoring.

During Delivery

• Vaginal delivery preferred in most cases (unless contraindicated).
• Continuous ECG and oxygen monitoring.
• Epidural anesthesia preferred to minimize hemodynamic stress.

Postpartum Period

• Close observation for heart failure, thromboembolism, or arrhythmia for at least 6 weeks postpartum.
• Encourage breastfeeding if medication-safe.
• Lifestyle modification counseling for long-term cardiovascular health.

Emerging Trends & Innovations

• Cardio-Obstetric Clinics in AIIMS, PGI Chandigarh, and major tertiary hospitals providing integrated cardiac-pregnancy care.
• AI-based echocardiography tools predicting heart failure risk.
• Wearable heart rate & BP monitors for remote tracking.
• Maternal cardiac registries in India (launched in 2024) to improve outcome data.

Expert Insights

“Cardiovascular disease is the new frontier in maternal mortality — silent, underdiagnosed, but preventable.”
— Dr. S. Raghavan, AIIMS Cardio-Obstetrics Unit, 2025

“Every obstetrician must think like a cardiologist when a pregnant woman presents with breathlessness or fatigue.”
— Federation of Obstetric & Gynaecological Societies of India (FOGSI), 2024

 Summary

Aspect	Key Point
Rising Threat	Cardiovascular disorders are now a leading cause of maternal mortality.
Common Issues	Hypertension, peripartum cardiomyopathy, arrhythmias, congenital & ischemic heart disease.
Why Dangerous	Symptoms often mimic normal pregnancy; diagnosis delayed.
Prevention	Preconception screening, regular cardiac monitoring, multidisciplinary care.
Goal	Integrate cardiac care into every stage of pregnancy — from planning to postpartum.

Healthy heart, healthy pregnancy.
Early screening, consistent monitoring, and awareness are the strongest shields against maternal cardiac complications.