Overview
Thinking about having a baby but worried about your heart condition?
Mitral valve disease (MVD) is a condition affecting the mitral valve, a crucial part of your heart. A healthy mitral valve ensures smooth blood flow within the heart. However, MVD can disrupt this flow, leading to complications during pregnancy. This article explores MVD, its impact on pregnancy, and management strategies for a safe and healthy pregnancy journey.
Understanding mitral valve disease
What is the mitral valve?
The mitral valve, located between your heart’s left atrium and the ventricle of your heart, acts as a one-way door. It opens during blood flow from the atrium to the ventricle and closes tightly to prevent backflow. This ensures adequate blood flow throughout your body.1
Types of mitral valve disease
There are two main types of MVD, each affecting blood flow differently:
Stenosis (narrowing)
The mitral valve opening narrows, restricting blood flow from the atrium to the ventricle. This can cause blood to back up in the atrium, leading to pressure buildup and symptoms like fatigue and shortness of breath.
Regurgitation (leakage)
The mitral valve doesn't close properly, causing some blood to leak back into the atrium. This reduces the amount of blood reaching the ventricle and eventually, the body, leading to fatigue and shortness of breath.
Causes of mitral valve disease
Several factors can contribute to MVD development:2,3
- Rheumatic fever: A complication of untreated strep throat can damage the mitral valve
- Congenital heart defects: Certain heart defects present at birth can affect the mitral valve
- Degenerative changes: Wear and tear over time can weaken the mitral valve structure
- Heart attack: A previous heart attack can damage the mitral valve tissue
Pregnancy and the heart
Physiological changes in pregnancy
Pregnancy significantly alters your cardiovascular system to support the growing baby. These changes include [4]:
- Increased blood volume: Blood volume increases by up to 40% to nourish the foetus
- Increased heart rate: Your heart rate rises by 10-20 beats per minute to pump more blood
- Decreased systemic vascular resistance: Blood vessels relax, reducing resistance to blood flow, and catering to the increased blood volume
How pregnancy affects the heart
These physiological changes place a greater workload on the heart. While a healthy heart adapts well, MVD can make it difficult to handle the increased demand. This can worsen existing symptoms of MVD and increase the risk of complications.
Mitral valve disease and pregnancy risks
Impact on the pregnant parent:3,5
- Heart failure: MVD, particularly stenosis, can worsen due to increased blood volume and pressure in the atria. This can lead to heart failure symptoms like fatigue, shortness of breath, and swelling in the legs and ankles (oedema)
- Arrhythmias: Abnormal heart rhythms like atrial fibrillation are more common in people assigned female at birth (AFAB) with MVD during pregnancy, increasing the risk of complications like stroke and blood clots
- Other complications: MVD can increase the risk of infections in the heart lining (endocarditis) and pulmonary hypertension (high blood pressure in the lungs) during pregnancy
Impact on the foetus:3,5
- Preterm birth: MVD can restrict blood flow to the placenta, potentially leading to premature birth
- Foetal growth restriction: Reduced blood flow due to MVD may limit the nutrients and oxygen reaching the foetus, hindering its growth
- Increased risk of complications: MVD can increase the risk of miscarriage, stillbirth, and birth defects in the baby
Management
Early diagnosis and proper management are crucial for a safe pregnancy with MVD. Here's what you can expect:5,6
Preconception counselling
Consulting a cardiologist before pregnancy allows for a thorough evaluation of your MVD severity and potential risks. This helps determine if valve repair or replacement surgery might be necessary before conception.
Importance of a high-risk pregnancy team
A team approach involving your cardiologist, obstetrician (pregnancy specialist), and other specialists (if needed) is crucial for comprehensive care throughout pregnancy.
Medications during pregnancy
Certain medications may be used to manage symptoms and prevent complications. However, due to potential foetal risks, the doctor will carefully select medications safe for pregnancy.
Monitoring throughout pregnancy
Regular checkups with your doctor and cardiologist are essential. Echocardiograms (ultrasound of the heart) will be used to monitor your valve function and heart health. Frequent monitoring allows for early detection of any complications and timely intervention.
Delivery planning: vaginal vs. caesarean section
The mode of delivery (vaginal birth or cesarean section) will be decided based on your MVD severity, overall health, and the baby's well-being. Vaginal delivery is preferred for most AFAB people with well-controlled MVD. Caesarean section (also called C-section) may be recommended for high-risk cases to minimise strain on the heart.
Seek medical care
It is important to contact your healthcare professional right away if you experience chest discomfort, rapid or irregular heartbeat, or difficulty breathing during physical activity. Your healthcare provider may suggest consulting a specialist in heart conditions.
If you've been diagnosed with mitral valve stenosis but haven't experienced any symptoms, inquire with your healthcare provider about the recommended frequency of follow-up examinations.
FAQ’s
Can I get pregnant with mitral valve disease?
In most cases, yes. However, preconception counselling with a cardiologist is essential to assess the severity of your valve disease, its potential impact on pregnancy, and your overall heart health. They can advise on the risks and tailor a plan to optimise pregnancy outcomes.
What are the risks of pregnancy with mitral valve disease?
The risks vary depending on the severity of your MVD. Complications can include heart failure, arrhythmias, preterm birth, and foetal growth restriction. A cardiologist can assess your individual risks.
What medications can I take during pregnancy for mitral valve disease?
Medications used to manage mitral valve disease are carefully reviewed for foetal safety. Options may include diuretics, blood thinners in some cases, and antibiotics for ongoing endocarditis. Your doctor will determine the safest and most effective course of treatment for you.
What kind of monitoring will I need during pregnancy?
Close monitoring throughout pregnancy is crucial. This may involve regular checkups with a cardiologist and obstetrician, echocardiograms to evaluate your heart function, and foetal ultrasounds to monitor your baby's growth and development.
Will I have a vaginal delivery or caesarean section?
The delivery method is decided on a case-by-case basis. Valve severity, functional class, and potential complications during labour are all considered. Your doctor will discuss the safest option for you and your baby.
I'm anxious about pregnancy with mitral valve disease. What can I do?
Talking to your doctor about your concerns is essential. They can address your specific questions and provide reassurance. Consider joining a support group for AFAB people with heart disease or mitral valve disease.
What are the signs of complications during pregnancy?
Be aware of symptoms like worsening shortness of breath, fatigue, chest pain, or rapid heart palpitations. These could indicate complications and require immediate medical attention.
What can I do to have a healthy pregnancy with MVD?
Maintaining a healthy lifestyle, including a balanced diet, regular exercise (as approved by your doctor), and managing stress can all help to ensure a healthy pregnancy with MVD. Adhere to all your doctor's recommendations and attend prenatal visits diligently.
Summary
Mitral valve disease can present challenges during pregnancy, but with careful planning and comprehensive care, AFAB people with this condition can increase their chances of a healthy pregnancy. This involves preconception counselling, close monitoring by a team of specialists, and potentially medication adjustments. By proactively managing mitral valve disease, successful pregnancy and delivery are achievable for many AFAB people.
References
- Mayo Clinic [Internet]. [cited 2024 Jun 25]. Mitral valve stenosis - Symptoms and causes. Available from: https://www.mayoclinic.org/diseases-conditions/mitral-valve-stenosis/symptoms-causes/syc-20353159
- Nanna M, Stergiopoulos K. Pregnancy complicated by valvular heart disease: an update. JAHA [Internet]. 2014 May 22 [cited 2024 Jun 25];3(3):e000712. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.113.000712
- Van Hagen IM, Thorne SA, Taha N, Youssef G, Elnagar A, Gabriel H, et al. Pregnancy outcomes in women with rheumatic mitral valve disease: results from the registry of pregnancy and cardiac disease. Circulation [Internet]. 2018 Feb 20 [cited 2024 Jun 25];137(8):806–16. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.032561
- Cornette J, Roos-Hesselink JW. Normal cardiovascular adaptation to pregnancy. In: Stergiopoulos K, Brown DL, editors. Evidence-Based Cardiology Consult [Internet]. London: Springer; 2014 [cited 2024 Jun 25]. p. 423–32. Available from: https://doi.org/10.1007/978-1-4471-4441-0_29
- Tsiaras S, Poppas A. Mitral valve disease in pregnancy: outcomes and management. Obstet Med [Internet]. 2009 Mar [cited 2024 Jun 25];2(1):6–10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989773/
- American College of Cardiology [Internet]. [cited 2024 Jun 25]. Valvular heart disease in pregnancy. Available from: https://www.acc.org/latest-in-cardiology/articles/2018/02/12/07/29/http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2farticles%2f2018%2f02%2f12%2f07%2f29%2fvalvular-heart-disease-in-pregnancy
