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Issues for the mother
Which forms of birth control are safe?
Some forms of birth control (medical term: contraceptives) are not safe for women with CAD. Contraceptive pills containing estrogen are not recommended in women with CAD because they are associated with the formation of blood clots. However, there are other acceptable contraceptive methods such as progesterone-only contraception or intrauterine devices (IUD). (see Birth Control) Contraceptive selection should be discussed with a physician who has an understanding of your underlying heart condition.
What are my risks if I become pregnant?
In order to determine your risk during pregnancy, you should see your heart specialist before getting pregnant. You may be required to have additional heart tests such as an echocardiogram or stress testing on a treadmill or a bicycle or with a drug. Some stress tests may also image the heart with echocardiograms (ultrasound) or nuclear medicine imaging techniques.
Some women with milder forms of CAD may not develop symptoms during pregnancy. Women with more significant forms of CAD may develop chest pain, tightness (medical term: angina), or heart attacks. A heart attack can be very serious and is associated with a risk of death. Heart attacks can occur at any time during pregnancy, although the highest occurrence is in the third trimester (28-40 weeks gestation).
Spontaneous coronary artery tearing is a rare, but a very serious event. Women who have this complication of pregnancy typically develop it late in pregnancy or in the early days after delivery. They have chest pain like the pain of heart attacks due to other sorts of CAD.
Women with CAD are often treated with aspirin or beta blockers, and both can be used during pregnancy when necessary. Other medications, like those used to treat high cholesterol, may not be safe during pregnancy. Do not stop medications without first checking with your doctor, but do check your medications out before pregnancy so you will have a plan. If you did not do that, then do so as soon as you know you are pregnant. The MOTHERISK website is an excellent resource.
