Pregnancy can affect your health, even if you don’t have any known health conditions. If you live with hypertrophic cardiomyopathy (HCM), you may need extra care before and during pregnancy.

It’s important to know how HCM can affect your heart and your pregnancy. With support from your healthcare team, it’s possible to have a healthy pregnancy and delivery.

If you are pregnant or want to become pregnant, you may work with a team that includes a genetic counselor, a cardiologist, and an obstetrician.

Here, we cover what to expect before and during pregnancy with HCM, including what your medical care may look like.

Planning for Pregnancy With Hypertrophic Cardiomyopathy

Prepregnancy planning can help you prepare for pregnancy, delivery, and the weeks and months after birth. If you’re planning a pregnancy, talk with your HCM specialist or cardiologist. They can coordinate your care with your maternal-fetal medicine specialist.

Some people don’t realize they have HCM until they’re pregnant. If your healthcare team discovers HCM during one of your prenatal visits, they can make sure you receive the care you need.

Here’s what you can expect before pregnancy if you have HCM.

Visits and Tests Before Pregnancy

Before pregnancy, your healthcare team will do a physical exam to check your current health. They’ll also review your medical history and ask about any heart conditions in your family.

Your doctor will ask whether close family members across the past three generations had heart disease, abnormal heart rhythms, or sudden, unexpected death.

Based on what they find, your healthcare team will talk with you about possible risks and help you plan for the months ahead.

Review Your Medications

Before pregnancy, it’s important to review the medications you take. Some medications commonly taken for HCM, including cardiac myosin inhibitors, antiarrhythmic medications, and certain beta-blockers, may not be safe to take while pregnant.

You may be able to keep taking some of your current medications during pregnancy with close care from your doctor.

Discuss Genetic Risks

Before pregnancy, it’s important to talk to a genetic counselor. Genetic counseling can help you understand your baby’s chance of inheriting HCM.

Genetic testing uses a blood or saliva sample to look at genes linked to HCM. The goal is to see if you have a genetic variant, or change, that may cause HCM. Your genetic counselor will review the results with you.

If you’re thinking about in vitro fertilization, genetic testing can check an embryo for HCM-related gene changes before it’s placed in the uterus. This information can help with family planning. Talk to your genetic counselor about your options.

Pregnancy and Hypertrophic Cardiomyopathy

Your cardiovascular system changes during pregnancy to support the growing baby. These changes can strain your heart, which can put you at risk for some heart complications if you have HCM.

Here are some possible cardiovascular changes:

• Increased blood volume by 40 percent to 50 percent
• Expanded left ventricular cavity
• Less pressure in your blood vessels, which helps blood flow more easily
• Increased heart rate during the third trimester
• Major blood loss during childbirth

These and other changes can raise the risk of congestive heart failure for people with HCM.

According to the 2024 American Heart Association/American College of Cardiology guidelines for HCM, about 25 percent of pregnant women with HCM have heart symptoms during pregnancy, such as chest pain, palpitations, or arrhythmias.

Monitoring and Treatment During Pregnancy

It’s important to keep seeing your specialist team throughout pregnancy. You may need to work with a high-risk pregnancy specialist alongside a cardiologist and other providers to monitor your pregnancy and overall health.

Monitoring Your Pregnancy

Your prenatal visits may include specific tests to check your heart health and your baby’s health and growth.

You’ll most likely need to get a fetal echocardiogram, a specialized imaging test that shows the baby’s heart and blood flow, during your second and third trimesters. A fetal echocardiogram may also tell you if your baby has HCM before they’re born.

You may also need an echocardiogram if you notice new heart symptoms while pregnant. Most HCM complications happen during the third trimester, and an echocardiogram can help find changes early.

Be sure to attend all of your prenatal visits to keep up with recommended tests and monitoring.

Your healthcare team will monitor your blood pressure, heart rate, and other basic vital signs, too.

Possible Medication Adjustments

Some HCM medications may need to be changed during pregnancy. If you take beta-blockers or calcium channel blockers, your doctor may need to check on you more often. Don’t stop or change any medication unless your doctor tells you to.

Signs You Need Urgent Medical Care

Call your doctor immediately if you have any signs of congestive heart failure or dangerous arrhythmias while pregnant with HCM. It’s important to be aware that some normal pregnancy symptoms overlap with signs of heart failure.

Get in touch with your healthcare team right away if you notice:

• Very swollen legs and ankles
• Shortness of breath, especially while walking short distances or lying down
• A very fast heartbeat
• Chest pain
• Blurry vision
• Heart palpitations that continue for more than 30 seconds
• Fainting

Labor, Delivery, and Postpartum Considerations

Work with your pregnancy care team to plan your delivery early, ideally by the end of the second trimester. This is important because early delivery is more common in people with HCM.

Planning Your Delivery

If you’re pregnant and have HCM, vaginal delivery is usually the safest option, as long as there are no complications. In some cases, you might need a cesarean section (C-section). C-sections can be riskier for people with HCM because they can cause heavy blood loss, which can make HCM symptoms worse.

Pain Control Options

Epidural anesthesia can make your delivery more comfortable. If you need a C-section, the anesthesia team will choose the safest option for you. They may use epidural anesthesia or general anesthesia, depending on how you and the baby are doing.

Your healthcare team will discuss these and other pain relief options as you plan your delivery.

Postpartum Monitoring

Immediately after your delivery, your doctors will watch you and your baby closely for signs of complications, including atrial fibrillation and other arrhythmias.

Your care team will continue to monitor you for possible heart complications during postpartum follow-up visits for about six months.

According to the Journal of the American College of Cardiology, pregnancy with HCM isn’t linked to a higher risk of long-term heart complications.

Talk to Your Doctor

If you have HCM and are pregnant or considering pregnancy, talk to your doctor or cardiologist. They can explain your risks and help you plan for pregnancy and delivery.

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Did you notice any changes in your hypertrophic cardiomyopathy during pregnancy? Let others know in the comments below.