Cardiovascular Disease and Pregnancy Program

Cardiovascular disease is the number one cause of maternal mortality in the United States. While most people with pre-existing cardiovascular conditions can safely and successfully become pregnant, carry a baby to term, and breastfeed, patients with cardiovascular conditions are at higher risk of complications during pregnancy and after delivery. Pregnancy can also reveal or cause previously undiagnosed heart problems, and certain pregnancy complications can put patients at a higher risk for future cardiovascular disease.

Yale’s Cardiovascular Disease and Pregnancy Program brings together cardiologists, maternal-fetal medicine specialists, nutritionists, pharmacists, lactation consultants, social workers, and family planning specialists who utilize their unique expertise to provide comprehensive patient care. Our multidisciplinary team meets regularly to create individualized care plans for each pregnant patient with heart disease.

We provide care to:

• People with known heart disease, including congenital heart disease and acquired heart diseases, such as abnormal heart rhythms (arrhythmias), heart failure, and ischemic heart disease (coronary artery disease)
• People who develop cardiovascular disease or are newly diagnosed with heart disease during pregnancy (for example, peripartum cardiomyopathy)
• People who develop pregnancy-specific complications (including preeclampsia and related hypertensive disorders or gestational diabetes) that put them at higher risk for future cardiovascular disease

• Contraception counseling: We provide individualized contraception counseling to patients with cardiovascular conditions to help determine the best and most reliable form of contraception for them based on a variety of factors, including specific heart conditions, interaction with other medications, and personal preferences.
• Comprehensive risk assessment: We provide a comprehensive risk assessment for patients with heart conditions who wish to become pregnant. We coordinate care to ensure they receive updated imaging and diagnostic studies and are on pregnancy-safe medications before they conceive. We also work closely with patients to provide nutrition and exercise guidance.
• Preconception counseling: We provide consultations to explore and discuss a potential pregnancy and family building. During this visit, we will answer all patient questions and develop care recommendations to support patients prior to, during, and after pregnancy. We also introduce members of the care team.

• Prenatal care management: We work with patients to diagnose, treat, and manage heart conditions. We adjust medications, perform pregnancy-safe advanced cardiovascular imaging, plan for any procedures or surgeries that may be needed after delivery, manage heart complications, support anticipated lactation goals, and provide educational tools to support healthy lifestyles during pregnancy.
• Delivery planning and early postpartum care: Our multidisciplinary team works closely with our patients to develop a safe and meaningful delivery and early postpartum plan. Patients have access to childbirth education and parenting classes.

• Postpartum care: We provide robust outpatient postpartum care through in-person and telehealth visits.
• Neonatal intensive care unit and well newborn care: We collaborate with our pediatric colleagues to foster parent/newborn bonding, even when a patient’s early postpartum course requires specialized care.
• Lactation support: Most postpartum patients with heart conditions can successfully and safely breastfeed if they choose to. Our specialists provide evidence-based guidance to help determine which medications are safe to continue, address lactation challenges caused by cardiac conditions, medications, or procedures, and coordinate surgeries, procedures, and other care to make it easier to achieve success with breastfeeding and lactation.
• Postpartum blood pressure monitoring and preeclampsia care: Patients who are diagnosed with high blood pressure or preeclampsia during their pregnancy or the postpartum period may develop complications after birth and may be at increased risk for cardiovascular disease later in life. Our Maternal In Reach Team for Equity (MITEY) program remotely monitors patients’ blood pressure from the comfort of their homes for up to 12 weeks following delivery. Our team of physicians and trained advanced practice clinicians and physicians make real-time blood pressure medication changes and monitor for complications. After the initial postpartum period, we offer continued blood pressure monitoring and management, as well as comprehensive cardiovascular risk factor assessment and modification with a cardiology specialist through the Postpartum Hypertensive Disorders of Pregnancy Clinic Program. Support from a nutritionist and exercise physiologist is also available. This program helps patients understand their risk of future cardiovascular disease and how to work with their primary care provider to lower that risk over their lifetime.
• Perinatal mood support: Pregnancy and the postpartum period are life events that may trigger or exacerbate common mood disorders like depression and anxiety, particularly when there are medical complications or an exacerbation of chronic conditions at the time of delivery. We have expertise in identifying and diagnosing these conditions, as well as in initiating treatment and connecting patients to perinatal mental health specialists. Our Maternal Wellness Program provides mental health support and therapy to our peripartum patients.
• Postpartum cardiovascular risk assessments and guidance: We provide cardiovascular risk assessments to help guide decisions around lactation, future pregnancies, and future risk of cardiovascular disease. We also provide nutrition guidance and home exercise prescriptions so that patients have the support they need to eat well and exercise safely after pregnancy.
• Coordinate and transition care: Patients can continue receiving care through the Cardiovascular Disease and Pregnancy Program for one year after delivery. At that time, we will coordinate and help facilitate a safe transfer of care to appropriate providers and clinical programs within the Yale Health System, including primary care providers, the nationally accredited Adult Congenital Heart Disease Program, the Women’s Heart and Vascular Program, and the Preventive Cardiovascular Health Program, among others.