Pregnancy has always been viewed as a time of strong health, particularly for the heart. A majority of women who are pregnant are young, active, and free of chronic illness, and serious cardiac events in them are generally considered unlikely. However, heart attacks during pregnancy are becoming more common than they were a few decades ago, when they were considered medical curiosities.
Maternal mortality is the number of maternal deaths for every 100,000 live births. In 2023, 88 women died of maternal causes for every 100,000 live births, translating to roughly 22,500 maternal deaths for that year. approximately 3 in 100 cases per 100,000 deliveries. Although still rare — cardiac diseases complicate 1 to 4% pregnancies in India and acute myocardial infarctions occur in approximately 3 in 100 cases per 100,000 deliveries — early diagnosis and treatment are necessary as such cases can have serious implications for both the mother and baby. Raising awareness towards early diagnosis and timely treatment are of paramount importance.
Why the increase
Recent increases in pregnancy-related heart attacks are basically a mirror, reflecting the changes in maternal demographics and health. Delaying of, and later pregnancies at ages 35 or above, is one factor, as it is a time when the natural risk of cardiovascular disease starts to go up. Besides advancing age, the fact that there is more diabetes, obesity, high blood pressure, and lack of exercise in society has increased risk factors in pregnant women too.
Other major challenges have been the increased use of contraceptive pills (most of them having a pro clotting tendency), as well as advanced IVF treatments involving significant hormonal imbalances. One rare condition in the normal population, but which has a bigger incidence in pregnant women is spontaneous coronary dissection leading to acute myocardial infarction. This is rare, but challenging to deal with.
What pregnancy does
Pregnancy puts tremendous pressure on the heart as blood volume increases by almost 40%, and the heart must pump more blood to satisfy the needs of the foetus. Alongside this, pregnancy is a natural blood clotting condition which helps minimise bleeding at childbirth.
Adding to the challenge is the presentation of heart attacks in pregnancy. Symptoms are not as dramatic as the classic textbook presentation in a non-pregnant adult, with severe chest pain radiating to the arm typically not being obvious. Instead, patients often present with breathlessness, severe fatigue, nausea, vomiting, dizziness, sweating or jaw, back or upper abdominal pain. This can often lead to delays in diagnosis, which is another of the more frightening aspects of heart attacks in pregnancy. Both patients and clinicians can be misled into a false sense of security by the patient’s age and the fact that she is pregnant. Blood flow to the heart muscles becomes limited, making time critical. Hence, any kind of delay could have serious implications for the foetus.
Treatment and way forward
For procedures such as coronary angiography and stent placement, a specialised team is required, with professionals who have had previous experiences in handling such cases. For the best possible outcome, it is necessary for cardiologists, obstetricians, anaesthetists and neonatologists to work together.
Unfortunately, the availability of coordinated care for patients at risk is not uniform, and are particularly so in small centres. The risks can rise due to delayed referrals, lack of awareness and unavailability of access to specialist services.
Prevention and early detection, therefore, become crucial. If there is a risk of heart disease, the individual must have a comprehensive cardiovascular check-up either before pregnancy or at the earliest stages of pregnancy. Further, it is necessary to manage blood pressure, and blood sugar levels regularly. Alongside, eating a healthy diet, being physically fit and avoiding smoking can all help reduce the risk of heart diseases.
What women should know
Global data indicates that there is an increase in the number of deaths of mothers related to heart diseases, making it one of the main indirect causes for maternal mortality; these risks are increasingly being recognised.
Pregnancy does not give the heart any special protection: any individual who is pregnant and who has symptoms such as breathlessness, chest pain, fainting and sudden changes in their condition that cannot be explained should be prompted for an emergency cardiac examination.
Myocardial infarctions during pregnancy remain a rarity, but are nevertheless devastating. it is devastating. Detecting risks early and timely interventions can help ensure the pregnancy proceeds smoothly, joyously and without complications.
(Dr. P. Manokar is a senior interventional cardiologist and clinical lead – heart failure & transplant programme, Kauvery Hospital, Vadapalani. Pmanokar@hotmail.com)
Published – January 25, 2026 07:03 pm IST
