Pregnancy brings many changes to the body, including the heart and blood vessels. Most of these changes are normal, but some symptoms may be signs of a serious heart condition. This article explains what to watch for during pregnancy and when to seek medical care. Paying attention to these warning signs can help protect your health and your baby’s.

How Pregnancy Affects the Heart

During pregnancy, your heart works harder than ever. Your blood volume increases by 30 percent to 50 percent, and your heart rate rises by an extra 10 to 20 beats per minute.

These changes are normal and necessary, but they can put extra stress on your heart. For most people, the heart adapts well to these changes. However, if you have an existing heart condition or risk factors, you may develop complications.

Risk Factors for Heart Problems During Pregnancy

Certain factors can raise your risk of developing heart complications during pregnancy. Although pregnancy can cause heart problems in anyone, it’s more likely in those who:

• Are over the age of 40
• Are overweight
• Are of American Indian, African American, or Alaska Native descent
• Have preexisting heart conditions, such as heart valve disease or congenital heart disease
• Have certain health conditions, such as high blood pressure, diabetes, anemia, sleep apnea, blood-clotting disorders, or polycystic ovary syndrome (PCOS)
• Regularly smoke
• Take illegal drugs or opioids
• Drink alcohol
• Don’t get much physical exercise

8 Warning Signs of Heart Problems During Pregnancy

Although people with heart conditions can often safely have children and a normal pregnancy, there are a few signs to look out for. Keep in mind that everyone’s body is different, so always be sure to discuss any questions or concerns with your cardiologist (heart doctor) or healthcare provider.

1. Severe or Persistent Shortness of Breath

It’s common to experience some breathing changes during pregnancy. This may be because of increasing hormones and your growing uterus pressing against your diaphragm, the muscle below your lungs. You may feel like it’s really difficult to take a deep breath sometimes. Oftentimes, it’s easier to breathe later on in your pregnancy once the baby moves lower in your abdomen, closer to delivery.

However, if you’re having a lot of trouble breathing or it lasts for a long time, this could be a symptom of a heart problem. Let your doctor know if it’s very difficult for you to breathe or if you’re concerned about shortness of breath.

If you wake up gasping for air or can’t lie flat without feeling short of breath, it could be a sign of heart failure. These symptoms may happen because fluid builds up in the lungs when lying down — a condition known as orthopnea. Be sure to tell your doctor right away if you notice these symptoms so they can check your heart and recommend the right care.

2. Chest Pain or Pressure

During pregnancy, you may experience slight chest pain. This pain can also be caused by the growing fetus pressing on your organs. Severe chest pain that occurs all of a sudden should be evaluated by a healthcare professional. This could signify a heart attack or other serious conditions, like preeclampsia (a pregnancy complication involving high blood pressure that can affect the heart and other organs) or a blood clot in the lungs. It’s important to call for medical attention immediately if you’re experiencing severe or sudden chest pain.

3. Irregular or Rapid Heartbeat

Heart palpitations — when your heart feels like it’s pounding or beating very fast — occasionally happen during pregnancy. Usually, they’re nothing to worry about. However, it’s possible that heart palpitations could be a sign of an arrhythmia (abnormal heartbeat) or another heart problem. Arrhythmias don’t always require treatment during pregnancy because they usually go away after delivery. However, if you have a preexisting heart condition, you might need treatment.

If you notice your heart beating more than 100 beats per minute when you’re resting or the palpitations last longer than 30 seconds, you should seek medical care right away. Also, get immediate medical care if, along with heart palpitations, you’re experiencing:

• Bloody cough
• Chest pain
• Dizziness
• Trouble breathing

4. Severe Swelling

Weight gain and edema (swelling) in the feet and ankles are normal during pregnancy. However, severe swelling that comes on suddenly, especially in your hands and face, could be a sign of preeclampsia. This symptom is particularly concerning when this symptom is accompanied by other symptoms like lightheadedness, chest pain, and shortness of breath.

According to the American Heart Association, swelling toward the end of pregnancy or after delivery may be a sign of heart failure called peripartum cardiomyopathy (PPCM). The signs of PPCM — leg swelling and shortness of breath — make it difficult to diagnose PPCM because they’re common symptoms of pregnancy. If symptoms seem severe, echocardiography should be performed. Because these symptoms can look like preeclampsia, your healthcare provider should check any sudden or severe swelling during or after pregnancy right away.

Swelling, pain, or tenderness in one leg, especially the calf, could indicate deep vein thrombosis (DVT), a blood clot that can travel to the lungs (that condition is called pulmonary embolism). Mayo Clinic has found that pregnant women can have an increased risk of DVT due to more pressure in the veins of the legs and pelvis area.

5. Extreme Fatigue

Although it’s very common to be tired during pregnancy, extreme fatigue that lasts into your second trimester and doesn’t improve with rest may indicate underlying health concerns, especially involving the heart. If you’re too exhausted to do your normal daily activities, talk to your healthcare provider.

6. Lightheadedness or Severe Dizziness

Occasional lightheadedness can happen during pregnancy due to changes in your blood pressure. However, if your symptoms of lightheadedness or dizziness worsen, or you experience additional symptoms such as shortness of breath or blurred vision, tell your doctor immediately, as these can be signs of a heart condition.

7. Persistent Cough

It’s common to experience coughing, especially when your airway is exposed to an irritant, allergen, or infection. However, a new cough that doesn’t go away — especially one that gets worse when lying down or develops along with blood or pink mucus — may indicate fluid buildup in the lungs due to heart failure. Talk to your healthcare provider right away if you notice blood when you cough or if your cough doesn’t go away.

8. Severe Headaches With Visual Changes

Severe headaches and visual changes like sensitivity to light, temporary loss of vision, or blurry vision could be a sign of preeclampsia, which can affect the heart and other organs. Preeclampsia is a serious condition that can be life-threatening, if left untreated. High blood pressure and protein in your urine are two of the main symptoms that point to preeclampsia. Talk to your healthcare provider right away if you think you have preeclampsia.

When To Seek Immediate Medical Attention

Remember, during pregnancy, it’s always better to be cautious. If you’re concerned about a symptom, contact your healthcare provider. Emergency symptoms can be life-threatening and warrant a call to 911 or an immediate hospital visit. Don’t wait to get help if you experience:

• Belly or chest pain
• Shortness of breath or difficulty breathing
• Rapid or irregular heartbeat that doesn’t resolve with rest
• Extreme fatigue
• Severe swelling, especially if sudden
• Dizziness or lightheadedness
• Coughing up blood or mucus

Keeping Your Heart Healthy During Pregnancy

Even with risk factors, there are steps you can take to protect your heart during pregnancy:

Attend All Prenatal Appointments

Regular checkups allow your healthcare team to monitor your blood pressure, weight, and overall health. If you’re pregnant and have a heart condition, you may need specialized cardiac care during pregnancy. You may need to undergo tests like an echocardiogram or electrocardiogram.

Maintain a Heart-Healthy Diet

Work with your healthcare provider to make sure you’re getting the right nutrients to support the heart health of you and the baby. They may recommend focusing on a balanced diet of vegetables, fruits, lean proteins, and whole grains and limiting sugar, salt (sodium), and trans and saturated fat.

Stay Active

Your doctor can help you find safe ways to stay active during pregnancy that won’t put too much pressure on your heart. With your doctor’s approval, regular movement can support your overall health. Always check with your healthcare provider before trying any new physical activities.

Manage Stress

Pregnancy puts extra stress on your heart. Most people go through these changes without problems, but it’s important to know the warning signs of heart trouble so you can get help quickly if needed. Understanding your risk factors and making heart-healthy choices can help keep you and your baby healthy during this important time.

Talk With Others Who Understand

On MyHeartDiseaseTeam, the social network for people living with heart disease and their loved ones, more than 62,000 members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Are you currently pregnant, or have you been pregnant since your heart disease diagnosis? Do you have any advice for managing your heart health during pregnancy? Share your tips and experiences in a comment below, or start a conversation on your Activities page.