Even though Singapore has one of the lowest maternal death rates in the world, cardiovascular disease is still one of the top causes of maternal deaths. With more women choosing to have kids later in life, it’s becoming even more important to look after heart health during pregnancy. Dr. Kua Jieli, an Interventional Cardiologist at Carrington Cardiology and to: Dr Harvard Lin, Consultant Obstetrician, Gynaecologist and Urogynaecologist at the Asian Obstetric and Gynaecology Centre (AOGC) share expert tips on how to manage heart conditions during pregnancy and reduce long-term heart risks.
How Pregnancy Affects the Heart
During pregnancy, a woman’s body goes through a lot of changes to support the baby — especially the heart and blood vessels.
According to Dr. Kua, “Blood volume and the amount of blood the heart pumps go up by about 50%, while blood vessels relax and widen to help with flow, especially by the second trimester. The heart itself also changes; its size increases, and the main artery, the aorta, becomes more flexible.” These changes are caused by pregnancy hormones like oestrogen, progesterone, and relaxin, which also help the placenta grow and make sure the baby gets enough blood and nutrients.
For older mothers or women with pre-existing heart conditions, these changes can lead to complications like preeclampsia, stillbirth, early delivery, poor foetal growth, or heart problems during or after pregnancy, if not properly monitored.
Pregnancy Complications That Signal Future Heart Risk
Certain pregnancy complications serve as early indicators of heightened cardiovascular risk later in life. Dr. Kua identifies key conditions to watch for:
This is when a pregnant woman has high blood pressure and often protein in her urine. It’s linked to a 2 to 4 times higher risk of getting high blood pressure, heart disease, stroke, or heart failure in the future.
Gestational Hypertension
Gestational hypertension means high blood pressure that starts during pregnancy, but without protein in the urine. It may go away after delivery, but it can be an early sign that the woman might develop long-term high blood pressure or heart disease later on.
Gestational Diabetes
Gestational diabetes shows up during pregnancy but usually goes away afterwards. However, it raises the risk of getting type 2 diabetes, metabolic issues, and coronary artery disease down the road.
This is when the baby grows too slowly in the womb. It may point to issues with the mother’s blood flow or placenta, and could be a sign of deeper heart or blood vessel problems.
Pre-Term Birth
Giving birth too early can be linked to inflammation and blood vessel problems, which increase the mum’s long-term risk of heart disease.
Stillbirth
Women who experience stillbirth have a higher long-term risk of heart disease, including stroke and myocardial infarction.
“These complications may act as a ‘stress test’ that reveals hidden problems with blood vessels or metabolism,” Dr. Kua emphasises.
Recognising Early Signs of Cardiovascular Issues During Pregnancy
Many early heart disease symptoms mirror typical pregnancy complaints and are often dismissed. Dr. Kua advises paying close attention to:
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Chest pain
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Fatigue
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Light-headedness
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Tachycardia rapid heart rate (>100 bpm)
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Shortness of breath, especially at rest
- Persistent cough
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Swelling in the limbs
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Frequent nighttime urination
“Symptoms can appear during pregnancy or up to a year postpartum. If persistent, they may indicate a life-threatening cardiovascular condition,” he cautions.
How Can Pregnant Women Manage Heart Disease?
Managing heart conditions during pregnancy requires a combination of proactive planning, vigilant monitoring, and a team-based medical approach. According to Dr. Kua Jieli, “Managing heart problems during pregnancy involves careful planning, close monitoring, and a collaborative, multidisciplinary approach to ensure the safety of both mother and baby.”
For women with pre-existing cardiac conditions, preconception counselling is crucial. Risk assessments using tools such as the WHO maternal cardiovascular classification can guide treatment plans. Dr. Kua emphasises that medications like ACE inhibitors, statins, and warfarin should be substituted with pregnancy-safe alternatives before conception.
Throughout pregnancy, routine tests such as echocardiograms and ECGs help monitor heart function. Physicians closely observe symptoms like palpitations, shortness of breath, fatigue, and swelling, which may signal deterioration. Safe medications may include beta-blockers, low-dose diuretics for fluid control, and aspirin for preeclampsia risk reduction.
Dr. Kua notes, “Delivery planning must be individualized, although vaginal delivery is typically preferred unless contraindicated by cardiovascular status.” High-risk deliveries should occur in tertiary centres with cardiac support. Postpartum, the first six weeks are particularly critical, especially for patients with conditions like peripartum cardiomyopathy, necessitating continued monitoring.
Why is Postpartum Cardiovascular Screening Essential?
Despite the clear link between pregnancy complications and future cardiovascular disease (CVD), many postpartum programs omit heart health screening. Dr. Kua stresses that women with prior complications or existing heart disease must undergo routine assessments postpartum.
“A multidisciplinary care approach—starting from delivery and extending up to a year postpartum—can identify risks early and improve long-term outcomes,” he adds.
Common Myths About Pregnancy and Heart Health—Debunked
Misinformation can put maternal health at risk. Dr. Kua addresses prevalent myths:
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“Pregnancy is a time to enjoy eating for two people.” While it’s true that pregnant women need more nutrition, it should never be to the point that they’re meeting the caloric needs for two people. Excessive weight gain can increase the risk of diabetes and heart disease. A balanced diet is key. Plan to gain only 2.3kg in the first half of pregnancy and 0.5kg per week thereafter.
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“Eating spicy foods while pregnant can cause birth defects or harm the baby.” There is no evidence to suggest spicy foods can harm a developing foetus. But it may worsen heartburn, which can already be a problem during pregnancy.
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“It is harmful to the baby when women sleep on their back.” There’s no need to panic if a pregnant woman ends up sleeping on her back — but there’s a bit of truth behind the concern. As the baby bump gets bigger, it can press down on a big vein called the inferior vena cava, which brings blood back to the heart. When this vein gets squashed, less blood flows back to the heart and around the body, including to the womb. This might make some women feel dizzy, sweaty, or even a bit nauseous.
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“Keeping a pregnant woman’s heart rate lower than 140 bpm.” This outdated advice is no longer supported. Regular exercise won’t increase the risk of miscarriage, early delivery, or having a low birth weight baby. The U.S. Department of Health and Human Services actually recommends that pregnant women aim for about 150 minutes of moderate to intense exercise each week — and there’s no need to worry about sticking to a strict heart rate limit. However, it’s still important not to push yourself too hard.
What Are Preventive Measures to Avoid Heart Issues in Pregnant Women?
Preventive care is fundamental to reducing cardiovascular complications during pregnancy. A heart-healthy lifestyle—balanced nutrition, regular light-to-moderate exercise, and avoiding harmful substances like tobacco and alcohol—lays the groundwork for maternal well-being.
In addition to lifestyle, managing existing risk factors is essential. Conditions such as hypertension and diabetes must be controlled before and during pregnancy to prevent complications. Routine prenatal care allows early detection of warning signs, such as elevated blood pressure, which may indicate conditions like preeclampsia.
Education plays a pivotal role in prevention. Dr. Kua advises that women should seek immediate medical attention for “chest pain, severe breathlessness (especially at rest), rapid weight gain, palpitations, or episodes of fainting,” as these may indicate serious cardiovascular problems.
By empowering women with knowledge and ensuring timely medical intervention, many pregnancy-related heart complications can be mitigated or avoided altogether.
How Cardiologists and OB-GYNs Can Work Together
“Cardiologists and OB-GYNs can enhance maternal care by fostering a collaborative, multidisciplinary approach that begins before conception and extends well into the postpartum period.”
Starting with preconception counselling, It should include cardiovascular risk assessment, especially for those who are older, have high blood pressure, diabetes, or a history of heart problems
During pregnancy, doctors from different specialities can come together to create a joint care plan for women with heart issues, whether pre-existing or newly diagnosed. Regular updates between the teams help make sure treatments are adjusted when needed. For high-risk pregnancies, a team that includes maternal-foetal medicine specialists, cardiologists, and anaesthesiologists can work together to ensure safer delivery.
After giving birth, it’s still important to monitor heart health, as some conditions, like pregnancy-related heart conditions like peripartum cardiomyopathy or hypertension, can continue or even show up for the first time postpartum. Using shared health records, integrated care pathways, and joint clinics can help ensure mums get smooth, coordinated care at every stage.
Improving Healthcare Systems for Better Postpartum Heart Health
“Healthcare systems can enhance cardiovascular follow-up for postpartum women by emphasising the importance of a multidisciplinary, team-based approach to postpartum cardiovascular care.” Dr. Kua said.
This means cardiologists, OB-GYNs, maternal-foetal medicine specialists, and family doctors should all work closely together to make sure mums get smooth, continuous care from delivery to long-term heart management.
To prevent women with pregnancy-related heart risks from falling through the cracks, hospitals and clinics should set up structured referral systems and personalised follow-up plans. This includes identifying women who are more likely to face heart disease later and helping them manage things like high blood pressure, weight, cholesterol, and stress — especially in the first year after giving birth.
Healthcare professionals can also help by:
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Doing standard heart health checks before discharge and during follow-up visits.
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Using telehealth (video or phone consults) to make it easier for mums to attend appointments.
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Using digital tools, like health apps or reminders, to stay connected with new mums and keep them engaged in their care.
All these steps can help make sure that mothers get the heart care they need — not just during pregnancy, but well after the baby is born.
ABOUT DR KUA JIELI
Dr. Kua Jieli is a Senior Consultant Cardiologist specialised in interventional cardiology and serves as the Medical Director at Carrington Cardiology. He has extensive experience in managing complex coronary artery disease and a wide range of cardiovascular conditions. His expertise includes performing advanced interventional procedures such as left main disease, chronic total occlusions, and heavily calcified lesions.
