Pregnancy and heart disease

Pregnancy is often referred to as the ‘ultimate stress test’ for the body. During pregnancy, your heart works harder as it pumps much more blood around your body.

Some pregnancy complications can also be early warning signs for future heart problems and can increase your risk of heart disease. These include:

• High blood pressure during pregnancy
• Gestational diabetes (diabetes during pregnancy)
• Preterm birth (before 37 weeks)
• A small or large baby for their gestational age

Complications from heart disease can arise after delivery. Your post-natal care should continue into the fourth trimester (the first 12 weeks after birth).

If you have heart disease, you may need specialist care during your pregnancy.

Typically, this is provided through Pregnancy Heart Teams - multidisciplinary groups of cardiologists, midwives, and other specialists working together from preconception through postpartum.

While this level of specialist care is available in major hospitals in New Zealand, access to them remains inconsistent and often depends on where a woman lives rather than on her level of risk.

Current gaps in care put many women - especially those living in rural areas - at risk of complications during pregnancy.

Typically, this risk is addressed through Pregnancy Heart Teams: dedicated multidisciplinary teams that manage women with heart disease from before pregnancy, through pregnancy, delivery, and the postpartum period.

These teams were first recommended in the 2018 European Society of Cardiology (ESC) guidelines. The 2025 ESC guidelines now state that Pregnancy Heart Teams should be established in all referral hospitals, with care spanning pre-pregnancy through to post-partum follow-up.

New Zealand does not lack of expertise in this space, rather is less awareness of what constitutes a high-risk pregnancy, issues with access to streamlined funded services, and awareness of the importance of postpartum follow-up for women who have had cardiac issues during pregnancy.

Pregnant women in rural New Zealand face serious risks because there is no clear, nationally consistent pathway to access specialist heart care.

That’s why the Foundation is calling for a nationally-mandated referral pathway so women with known or suspected cardiac risk can access care rapidly.