For girls and young women with pacemakers, the dream of one day having children of their own was once only that—a dream. Over the last 25 years, medical breakthroughs and rapidly evolving pacemaker technology have made it possible for young recipients of pacemakers to have children of their own.
If you are a woman living with a pacemaker, defibrillator, or other implantable cardiac device, you should experience no impacts to your fertility or ability to have children. By keeping key health factors in mind, effectively managing your heart condition, and coordinating with your healthcare team, you can look forward to a safe pregnancy and healthy baby. Here is what you need to know in planning for pregnancy as a pacemaker recipient.
Key Considerations for Pregnant Women with Pacemakers
During pregnancy, your blood volume increases by up to 50% to support both you and your developing baby, meaning your heart has to work harder. You will experience an increased heart rate due to this increased cardiac output. In turn, this affects how your pacemaker works, as it is programmed to respond and adapt to your body’s changes—whether that be physiological, metabolic, or due to physical activity—to regulate your heart rate and rhythm.
Most modern pacemakers efficiently adapt to these changes, but you will most likely need special care to reduce the risk of complications for you and your baby. Here are some key factors to keep in mind and actions to take before you get pregnant or in the early days of pregnancy.
Understand Your Heart Condition
Your pacemaker device should not cause concerns or issues with your pregnancy. It is your underlying heart condition the pacemaker treats that can cause a high-risk pregnancy. That risk all depends on the type and severity of your heart condition.
Heart conditions that can increase pregnancy risk include:
- Aortic aneurysm
- Heart valve issues
- Congenital heart disease and defects
- Cardiomyopathy
- Congestive heart failure
- Heart rhythm disorders (e.g. arrhythmia, bradycardia, and heart block)
Your specific diagnosis matters when assessing your pregnancy risk. If your pacemaker is managing a condition that is stable with no other cardiac abnormalities, your pregnancy risk may be low. But if your heart condition is complex, progressive, or you have had a previous cardiac event/and or surgeries, more intensive monitoring may be required.
Review Your Medications
Another way your heart condition can complicate pregnancy is due to the medications you have to take. Some heart medications are not safe during pregnancy and can be harmful to a developing fetus. For example, the medication taken by patients with mechanical heart valves, which is needed to prevent valve clotting, can cause bleeding in the developing baby. Alternative injectable medications, rather than oral pills, should be used during pregnancy.
As a pacemaker recipient, you most likely need your device to treat a heart rhythm disorder. You are also likely taking complementary medications, such as antiarrhythmics, beta blockers, calcium channel blockers, and/or anticoagulants (blood thinners). However, you may need to adjust these medications well in advance of becoming pregnant. Discuss appropriate medications to use during pregnancy with your care team.
Coordinate with Your Care Team
If you are a pacemaker recipient who is thinking about starting a family or find you are pregnant (surprise!), the first action you will want to take is scheduling an appointment with your doctors. Yes, that is “doctors” plural, as your pregnancy will require a multidisciplinary care team.
You want to be sure your cardiologist is also a maternal cardiologist experienced in managing heart disease and cardiac conditions during pregnancy. If they are not, they should refer you to one. They will also coordinate with your electrophysiologist for awareness of any changes or specialized attention your pacemaker requires. You are probably already going to an OBGYN, but are they a high-risk OBGYN? If not, they can refer you to one or recommend a maternal-fetal medicine specialist.
Collaborative coordinated care between these specialists prioritizes your heart health while ensuring all aspects of your health and your developing baby are monitored throughout your pregnancy.
Pre-Pregnancy Evaluation
As part of this coordinated care, you will undergo a pre-pregnancy evaluation led by your cardiologist that should include:
- Echocardiogram and stress testing to evaluate heart function and determine your baseline.
- Cardiac clearance to determine if your heart can safely handle the increased strain of pregnancy.
- Pacemaker check to ensure your device is functioning properly and battery life is sufficient for the duration of the pregnancy.
- Medication review to adjust, discontinue, or substitute any medications that may be harmful to the developing fetus.
Safety Tips for Pregnancy with a Pacemaker
As your pregnancy progresses, it is important to take precautions to protect your heart and baby. Here are some key safety tips for effectively managing pregnancy with a pacemaker:
Know the Warning Signs and Symptoms to Watch For
Certain symptoms can signal that your heart is under stress and struggling with the demands of pregnancy or that your pacemaker needs adjustment. Be vigilant and contact your care team immediately if you experience new or worsening symptoms of:
- Shortness of breath, especially when at rest
- Rapid or irregular heartbeat
- Chest pain or tightness
- Dizziness or fainting spells
- Excessive fatigue, beyond typical pregnancy tiredness
- Persistent swelling in the legs, ankles, or face
- Palpitations or fluttering sensations in your chest
- Sudden weight gain (a possible sign of fluid retention)
Keep Up with Medical Checkups and Monitoring
Ongoing medical monitoring is essential to both you and your baby. Your care team may recommend more checkups and tests for you than the typical prenatal patient.
Prenatal visits, which are usually monthly in the first two trimesters, may be moved to a bi-weekly cadence sooner with more frequent ultrasounds and fetal monitoring scheduled to track your baby’s growth and development.
You should have regular heart checkups with your cardiologist at least once per trimester, but possibly more depending on your heart condition. These checkups can include echocardiograms to ensure your heart is handling the increased workload, discussing and adjusting medications, and checking your pacemaker.
Pacemaker checks are safe during pregnancy and typically use wireless telemetry to read pacemaker performance data, which poses no risk to your baby. You should have a pacemaker check every few months to ensure your device is working properly, as your pacemaker may need reprogramming as your pregnancy progresses.
Avoid High-Risk Activities
You want to stay active during your pregnancy, but this is not the time to push your physical limits. Gentle exercise, like walking or prenatal yoga, is usually safe and may even be encouraged by your doctors, but always check with your care team first before starting or continuing any fitness routine.
These activities are generally considered too high risk and should be avoided during pregnancy:
- Contact sports or high-impact exercises
- Weightlifting or lifting heavy objects, which can strain your heart and back
- Hot yoga or environments with high heat/humidity, which can cause dehydration or dizziness
- Activities with a fall risk (e.g., outdoor biking, hiking or climbing)
Maintain Heart-Healthy Habits
As a pacemaker recipient, you should already be managing your heart condition by maintaining heart-healthy habits. Practicing these habits is even more essential when you are pregnant due to the extra stress pregnancy places on your heart.
Make these heart-healthy habits part of your daily routine before, during, and after your pregnancy:
- Stay hydrated by drinking plenty of water throughout the day.
- Avoid getting overheated, especially in the first trimester, as it can stress your heart.
- Follow a balanced, heart-healthy diet rich in vegetables, fruits, lean proteins, whole grains, and healthy fats while limiting the intake of foods high in saturated fat, added sugars, and sodium that could contribute to fluid retention or high blood pressure.
- Reduce your stress with techniques like meditation, deep breathing, or prenatal yoga (if OKed by your doctor) that can help you refocus and calm your mind.
- Prioritize rest and get adequate sleep—seven to nine hours each night. Try different sleeping positions and use pillows to support or elevate your body if sleeping becomes difficult.
Join the Pacemaker Club: Connect with Others
Every woman’s situation is unique, but with the right care, the journey of pregnancy with a pacemaker can be both manageable and rewarding. If you are considering pregnancy and have a pacemaker, you can move forward confidently with the right information and support.
Find additional resources through the Pacemaker Club, an online community where you can connect with fellow pacemaker recipients to ask questions, share experiences, and support one another as you navigate all the ins and outs of pregnancy with a pacemaker.
