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Sarah Goldstein, MD, assistant professor of medicine (cardiovascular medicine), serves as the medical director for Cardiovascular Medicine of the Cardiovascular Disease and Pregnancy Program in partnership with the medical directors for Maternal-Fetal Medicine, Annalies Denoble, MD, MSC, assistant professor of medicine (obstetrics, gynecology, and reproductive services) and Katherine Campbell, MD, MPH, assistant professor of medicine (obstetrics, gynecology, and reproductive services).

In a recent Q&A session, Dr. Goldstein shared five critical insights regarding pregnancy and its impact on heart health.

1. Heart disease is the number one cause of maternal mortality in the United States – and it’s rising.

Heart disease accounts for more than a quarter of all pregnancy-related deaths and remains the leading cause of maternal mortality in the U.S. Dr. Goldstein attributes this to two main factors: women are becoming pregnant later in life when they are more likely to have heart disease or related risk factors; advancements in cardiology have enabled individuals with congenital heart disease to live into adulthood and consider pregnancy.

“The changes that the cardiovascular system must undergo to sustain a healthy pregnancy can be considered a 9-month stress test for the heart. Patients with cardiovascular disease may not be able to tolerate this, thus putting them at risk for complications related to their heart during or after pregnancy,” she said.

2. Most people with heart disease can carry a pregnancy safely if they receive appropriate care and monitoring during pregnancy and delivery.

Many adverse outcomes can be prevented with proper care. “Doctors can tell most people with heart disease that it is okay to get pregnant. Most patients can typically have a safe and successful pregnancy. All patients who are considering pregnancy should understand potential risks related to their cardiovascular disease,” said Dr. Goldstein.

3. For people with heart conditions, pregnancy should be carefully planned.

Dr. Goldstein emphasizes careful planning for pregnancies involving individuals with heart conditions. “It is important to perform comprehensive risk assessment, get up-to-date imaging and diagnostic studies, and make sure our patients are on pregnancy-safe medications before they conceive,” she said.

Reliable contraception is crucial for those of childbearing age with heart disease due to varying individual needs. “The best form of contraception may be different for each individual patient,” she noted.

4. Some conditions that emerge during pregnancy, like preeclampsia, are associated with an increased risk of future cardiovascular disease.

Adverse outcomes during pregnancy can provide insights into overall cardiovascular health. “It can be scary and disruptive for patients to experience preeclampsia around the time of their delivery,” said Dr. Goldstein.

Screening post-preeclampsia patients often reveals other cardiovascular risk factors such as elevated cholesterol or pre-diabetes which might otherwise go undetected early in life stages without such experiences during pregnancy.

5. Most people with heart disease can safely lactate or breastfeed if they want to.

Breastfeeding is generally feasible for most patients with heart disease but requires specific consultations regarding medication safety during lactation. The new Cardiovascular Disease and Pregnancy Program includes a lactation clinic aimed at providing necessary counseling for these patients.

“Lactation and breastfeeding are associated with lower rates of acquired heart disease and cardiovascular comorbidities later in life,” Dr. Goldstein remarked.

The Department of Internal Medicine at Yale School of Medicine continues its commitment by bringing together top clinicians, investigators, educators under one roof at one of the world's leading medical institutions.