If you have atrial fibrillation, a common type of arrhythmia or irregular heartbeat, and are pregnant or planning to try, you might wonder how it affects pregnancy. The good news is that every year, thousands of women with atrial fibrillation deliver healthy babies.
You’ll want to work closely with your doctor to make sure your heart medications are OK for pregnancy and know what signs to watch out for, just in case.
Planning Your Pregnancy
It’s safe to get pregnant when you have AFib, but you might have extra doctor visits once you’re expecting, to help prevent complications. Ideally, you should discuss with your doctor the possible effects AFib can have on a pregnancy before you become pregnant.
The most common medications that people take that cause the fetus to be at risk are blood thinners, medications to slow the heart down, or medications that try to maintain a normal rhythm.
You should talk to your doctor about what AFib prescriptions you might need to stop before you get pregnant. Some of these medications can harm your baby’s development in the first trimester, when organs are first developing. If you stop taking them before you’re pregnant, it can curb that risk. But you’ll need to work with your doctor to do that.
During pregnancy, your body makes more blood than usual, changes the flow of blood to direct more to your uterus (womb), and makes extra hormones that can change how organs, including your heart, and blood vessels work.
In turn, your heart actually grows and your heart rate speeds up.
Many healthy women notice heart palpitations, flutters in their chest, or skipped heartbeats while pregnant. If you already had AFib, all these changes can make you more likely to have heart rhythm problems come back or get worse. And for some women, who never had AFib before, pregnancy can be when it first starts. Doctors often diagnose new cases of AFib during the third trimester of pregnancy.
During pregnancy, AFib that’s not under control can make heart problems more likely. You may also be more likely to deliver a low birth weight baby, give birth too early, and to have pregnancy complications including pre-eclampsia. Because of these risks, you’ll probably have extra appointments with your doctor to make sure your pregnancy goes well and to check on how your heart is doing.
With atrial fibrillation, many times you will have regular visits with not only your obstetrician, but also with a cardiologist. Your doctors may recommend that you see a “high-risk” obstetrician, who is prepared for potential problems with the pregnancy.
Medicines While You’re Expecting
Which AFib medications are right for you during pregnancy depends on your particular case and how severe your AFib is.
Many medications carry risks during pregnancy, including a higher rate of birth defects, miscarriages, or premature labor. But bouts of atrial fibrillation can also be dangerous, potentially slowing the flow of blood going to your baby. You and your doctor will weigh the risks and benefits of different treatments for your individual case. You may switch medications or stop taking those for AFib completely during your pregnancy.
In general, AFib medications that are avoided during pregnancy include:
- Blood-thinning medications including warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis)
- Antiarrhythmia drugs including amiodarone, which has been linked to babies being born with hypothyroidism (underactive thyroid)
- Verapamil and diltiazem may raise the odds of birth defects and heart problems.
Some AFib medications have better safety records during pregnancy. So your doctor may recommend that you switch to a different drug.
For instance, you could get aspirin (during the second and third trimesters) or heparin to thin your blood and reduce the risk of blood clots.
Doctors often prefer the beta-blockers atenolol, labetalol, and metoprolol over other beta-blockers, which are drugs that lower blood pressure and slow your heart rate, to help control the atrial fibrillation.
Digoxin, a common heart disease medication, is considered safe during pregnancy and is one of the preferred medications for pregnant women with AFib.
Quinidine, which you take by IV, also seems to be safe to take during pregnancy.
When to Call Your Doctor
If you have AFib and are pregnant, you should watch for signs of blood clots, including:
- Swelling, redness, and pain in an arm or leg
- A fast heartbeat
- Trouble or pain with breathing
- Chest pain or tightness
- Pain that extends to your shoulder, arm, back, or jaw
- Sudden weakness or numbness of your face, arm, or leg
- Sudden trouble speaking or understanding speech
- Sudden changes in your vision
You should also call your doctor if you have signs of a new or worsening arrhythmia. These include:
AFib During and After Giving Birth
When you near the end of your pregnancy, your doctor might change your medications again so that you’re not taking any blood thinners immediately before or during labor and delivery.
During labor, your doctor will track how your heart is doing, to make sure the stress of giving birth doesn’t cause a heart rhythm problem, or arrhythmia.
After you deliver your baby, you will be able to take blood-thinning medicines again. Your doctor may need to adjust your medication plan if you plan to breastfeed your little one.