John Fawkner Cardiology The Heart Specialists
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Patient Information

Cardio-Obstetrics

A plain-language guide to cardiovascular conditions in pregnancy — what each condition involves, why it matters, and what to expect from assessment, monitoring, and follow-up care.

01

Preeclampsia

A pregnancy-related condition involving high blood pressure and organ involvement

Overview

Preeclampsia is a condition that arises after 20 weeks of pregnancy, characterised by elevated blood pressure together with signs of organ dysfunction. It commonly involves protein in the urine, but may also affect the liver, kidneys, brain, and clotting system. The condition can pose serious risks to both mother and baby, including preterm birth, placental complications, and progression to eclampsia — a severe form of the condition involving seizures.

Management during pregnancy

The appropriate management of preeclampsia depends on the severity of the condition and the gestational age at the time of diagnosis. For less severe presentations, close monitoring of blood pressure, regular blood tests, and urine protein measurement are essential. In more severe cases, blood pressure-lowering medications are used, and delivery may need to be expedited to protect the health of both mother and baby. All management decisions are made in close collaboration between the obstetrician, obstetric medicine physician, and cardiologist.

After delivery and long-term follow-up

High blood pressure and related complications can persist after delivery, sometimes for several weeks, making postpartum monitoring an important part of care. Beyond the immediate postnatal period, preeclampsia is now well recognised as an early marker of future cardiovascular risk. Women who have experienced preeclampsia have a higher lifetime risk of hypertension, heart disease, and stroke. For this reason, regular long-term cardiovascular risk assessment is recommended, and your cardiologist can help coordinate this as part of your ongoing care.

02

Gestational Diabetes

Elevated blood glucose arising during pregnancy

Overview

Gestational diabetes is a form of diabetes that develops during pregnancy, typically diagnosed in the second or third trimester through routine screening. Most women have no symptoms, and the condition would not otherwise be detected without testing. When blood glucose levels are not well controlled, gestational diabetes can increase the risk of complications including a large-for-gestational-age infant, birth trauma, and low blood sugar in the newborn after delivery.

Management during pregnancy

Regular monitoring of blood glucose levels is central to management. Dietary modification and consistent physical activity are the first-line measures, and are effective in the majority of cases. When blood sugar targets cannot be achieved through lifestyle measures alone, insulin is generally the preferred treatment during pregnancy, as it does not cross the placenta and has a well-established safety profile in this setting. Close collaboration between the obstetric and diabetes teams ensures that glucose targets are maintained throughout the pregnancy.

After delivery and long-term follow-up

Blood glucose levels typically return to normal after delivery, but follow-up testing in the months after birth is essential to confirm this. Gestational diabetes significantly increases the long-term risk of developing type 2 diabetes and cardiovascular disease. Ongoing screening for type 2 diabetes, combined with regular cardiovascular risk assessment, is recommended for all women who have had gestational diabetes — even if glucose levels have fully normalised after delivery.

03

Heart Disease in Pregnancy

Also referred to as cardio-obstetrics; encompasses pre-existing and newly diagnosed cardiac conditions

Overview

Pregnancy places considerable demands on the cardiovascular system. Blood volume increases substantially, cardiac output rises, and the heart rate is higher throughout gestation. These changes are well tolerated by most women, but in those with pre-existing heart disease — or in whom cardiac disease is first unmasked by pregnancy — they can lead to significant complications. Conditions encountered in this setting include congenital heart disease, cardiomyopathy, valvular heart disease, ischaemic heart disease, and arrhythmias. Symptoms such as breathlessness, fatigue, palpitations, or chest discomfort warrant prompt cardiology assessment, as they may reflect an underlying cardiac condition rather than the expected changes of pregnancy.

Management during pregnancy

A multidisciplinary approach is essential, involving cardiologists, obstetricians, and obstetric medicine physicians working together throughout the pregnancy. For women with known cardiac disease, pre-pregnancy evaluation is strongly recommended to assess risk, optimise cardiac status, and discuss the implications of pregnancy before conception occurs. During pregnancy, regular cardiology review at intervals appropriate to the severity of the condition allows early detection of deterioration. Careful delivery planning — including the timing, location, and mode of delivery — is an integral part of care and is tailored to each patient's cardiac diagnosis and functional status.

After delivery and long-term follow-up

Haemodynamic changes do not resolve immediately after delivery. The early postpartum period can be a particularly vulnerable time for women with cardiac disease, as fluid redistribution and changes in cardiovascular load occur in the days and weeks following birth. Ongoing cardiology surveillance after delivery is recommended, with the frequency and nature of follow-up determined by the underlying cardiac condition. For women planning further pregnancies, preconception review with a cardiologist is an important opportunity to reassess cardiac status and plan care in advance.

04

Peripartum Cardiomyopathy

Heart failure arising in late pregnancy or the months following delivery

Overview

Peripartum cardiomyopathy is a form of heart failure that develops in the final weeks of pregnancy or within the first several months after delivery, in women without a prior history of heart disease. It is characterised by reduced heart muscle function, leading to symptoms of heart failure including breathlessness, fatigue, and swelling of the legs and ankles. The exact cause is not fully understood, but the condition is thought to involve a combination of hormonal, inflammatory, and immune factors unique to the peripartum period.

Management

Treatment follows the same principles as for other forms of heart failure, but requires careful adjustment of medications to ensure safety for both mother and baby — particularly when the condition arises during pregnancy or while breastfeeding. Echocardiography is used to monitor heart function at regular intervals, both during and after pregnancy. In most cases, heart function improves substantially over the months following delivery, though the degree of recovery varies between individuals. In cases where recovery is incomplete, longer-term heart failure management is continued under cardiology care.

Future pregnancies

Peripartum cardiomyopathy carries implications for future pregnancies. Even in women whose heart function has fully normalised, subsequent pregnancies carry a risk of recurrence, and this risk is higher in those with persistent reduction in heart muscle function. Preconception counselling with a cardiologist is essential before any future pregnancy is considered. This allows a thorough assessment of current cardiac status, an informed discussion of the risks involved, and the development of a monitoring and management plan that is in place from the outset of any subsequent pregnancy.