If you are pregnant or plan to become pregnant, it is essential to prioritize heart health to encourage a healthy journey for both mother and baby.

A heart-healthy pregnancy involves a combination of:

• Pre-pregnancy preparation
• Regular exercise
• Managing hypertension if it arises.
• Nutritious diet
• Diligent monitoring

By focusing on these key areas, you can increase your chances of a healthy pregnancy.

Pre-pregnancy health as the foundation

A heart-healthy pregnancy starts long before conception, says maternal-fetal medicine specialist Neil Hamill, MD.

“It is foundational that we enter pregnancy with as fit a physique as we can, so we want to maximize weight loss,” Dr. Hamill says. “We’re also going to want chronic health conditions either resolved or as stable as they can be for at least six months leading up to pregnancy – particularly chronic hypertension.”

Dr. Hamill suggests checking in with your obstetrician to discuss goals, such as ideal blood pressure, before proceeding with pregnancy. 

“Hitting lifestyle goals before pregnancy happens is our best tool for success during pregnancy,” he says. “If we can move the needle a little bit, maybe we minimize disease severity or dodge disease occurrence.”

The role of exercise

Physical activity is essential for heart health, and this remains the case during pregnancy. If you have not regularly exercised in the past, pregnancy is a great time to start.

“For families that don’t exercise, walking counts,” Dr. Hamill says. “If it’s winter, they can get to a mall and walk circuits inside; that counts. Being active is important.”

For those with established exercise routines, most activities remain safe during pregnancy, with a few exceptions like kickboxing and downhill skiing. Running, swimming and other cardiovascular exercises are encouraged, but increased hydration is important as dehydration occurs more easily during pregnancy.

Managing hypertension

Around 15% of mothers will experience hypertension, or high blood pressure, during pregnancy. This increases the risk to mothers and babies and significantly impacts the placenta, which supports the pregnancy.

“If you think about it, the placenta is just a giant bag of blood vessels,” Dr. Hamill says. “That organ is going to be tremendously impacted when chronic hypertension is present, and we’ll see a gamut of complications from that.”

Complications from hypertension in pregnancy include:

• Pre-eclampsia
• Smaller babies
• Early delivery
• Stroke and stillbirth in the most severe cases.

“We're starting to see that we can prevent complications like stroke if we maintain a blood pressure below 140,” Dr. Hamill says. “So, using medication aggressively to be at or below that goal is our pregnancy goal for hypertension.

Nutrition in pregnancy

Diet plays a crucial role in maintaining heart health during pregnancy. A diet high in fiber, including whole grains, fruits, vegetables, lean protein and healthy fats is recommended.

Vegetables like broccoli, spinach, squash, zucchini and cauliflower are excellent choices as they are high in both folic acid and iron, essential nutrients for pregnancy. Some pregnant women may also take supplements, like a prenatal vitamin containing folic acid.

“Folic acid is a safe supplement,” Dr. Hamill says. “Our food delivery system has been great about fortifying our foods with folic acid, but we often see families that want to supplement that with an additional milligram of folic acid.”

If you are concerned about getting enough of the proper nutrients, check with your provider. They can make individualized recommendations based on your needs.

Staying aware

Monitoring your heart health throughout pregnancy can be done using a few simple tools:

• Scale: Regular, but not obsessive, tracking of weight can help.
• Resting pulse: A decreasing resting heart rate can indicate improved fitness.
• Home blood pressure monitoring: Essential for those with hypertension to ensure medication is effective.

Pregnant women should be aware of the signs and symptoms of heart issues. Unlike men, women may not experience typical heart attack symptoms. Instead, they might feel:

• Numbness
• Weakness
• Tingling
• Chest pain
• Shortness of breath, especially during physical activity. 

Tell your provider promptly if you are experiencing any new or different sensations.

Frequent monitoring

Regular monitoring of the baby's size and blood flow parameters is essential. In some cases, additional ultrasounds and fetal testing may be necessary to ensure the baby’s well-being and reduce the risk of stillbirth.

For mothers who have hypertension, frequent medical visits may be necessary to monitor health, adjust medication and ensure blood pressure remains in a safe range. This may include weekly or twice-weekly testing in a clinic.

“We recognize that's a lot of time burden on a family, but the reassurance that we can offer in return is the goal,” Dr. Hamill says. “It lets us stretch a pregnancy further and get those additional benefits of the extra weeks.”

By staying in close communication with your provider and focusing on key preventive factors, you are protecting your heart health and laying the foundation for a healthy future for your child.