Challenges of Pregnancy with an LVAD

Although an LVAD is used in older adult patients as a treatment for advanced heart failure, it is also rarely seen in the younger population and women of childbearing age. Many cases have been reported in which women had a pregnancy, and surely they were not the easy ones. 

Some pregnancies are difficult, but the challenges that come with a Left Ventricular Assist Device (LVAD) during pregnancy are something that needs to be addressed. Pregnancy is something that comes with excitement and many hopes, but when you are still adjusting to your mechanical heart pump, it can feel like something you never expected. Pregnancy with an LVAD is extremely rare, but it is not impossible, and most importantly, it is something that deserves attention. 

Whether you are a patient or you need to understand the challenges as a healthcare professional, making an informed decision and managing those challenges carefully should be our goal. 

Let’s talk about how LVAD makes pregnancy so complex. 

Heart Diseases and Pregnancy:

When a women with some heart disease get pregnant, it may take things to another level. Well, most women can bear childbirth even during a cardiac issue, but sometimes it can turn into a serious situation that can also be life-threatening. One of the more common causes of complications among pregnant women is an underlying heart condition. 

The reason behind this is that when you get pregnant, your body has to work hard so that it can adjust to the new change. Your heart may have an increased workload to supply enough oxygen and nutrition for a baby to develop normally. So, when a heart condition is not supporting the new life due to some disease like cardiomyopathy, myocardial ischemia, or arrhythmias, it ultimately ends up causing you trouble. 

What happens if pregnancy occurs during treatment?

Having a disease and pregnancy is one thing, but what if pregnancy occurs during your treatment for heart disease? Let’s understand this with a real-life scenario. Imagine you have made it through the most difficult part of your life when dealing with heart failure, and now you have the support of an LVAD that helps your heart pump blood. You have just made peace with your new normal, and then comes something unexpected: your pregnancy.  

Whether it was planned or unplanned, this may cause you to experience a mix of emotions. But the truth is, pregnancy after LVAD implantation is a risky scenario. Although only a few healthcare professionals have seen this, it does happen. If anything happens to you like this, your every step must be taken with caution, under the supervision of professionals, and with emotional support.

This is not about one life anymore; now it’s about two. So, your LVAD now needs to support two lives at once.

Can you get Pregnant with an LVAD?

Well, if we talk about the possibility of getting pregnant with an LVAD, then yes, it is possible. But the even better concern is: Should you plan a pregnancy? Well, this is not about saying yes or no because things here can get messy due to both medical and emotional concerns.

An LVAD is a mechanical device that takes over the function of the heart in pumping blood when it becomes too weak. But what you need to understand here is that LVAD does not cure heart disease and only improves the symptoms by restoring circulation. 

Pregnancy comes with major body changes, and that includes increased blood volume, fluctuation in hormones, and cardiac workload. So, for someone who has an LVAD, it may create a perfect storm of challenges. And that is why doctors strongly advise against becoming pregnant with an LVAD.

Why is Pregnancy Considered High-Risk after an LVAD?

Simply put, LVAD can make your pregnancy a whole new level of complexity. Here are some of the reasons:

Hemodynamic Stress: 

Hemodynamics means how your blood flows through your blood vessels. It is a normal change during pregnancy that the following things will be increased:

• Heart Rate (How many times your heart beats in a minute)
• Cardiac Output (Amount of blood pumped by the heart per minute)
• Blood Volume (Amount of blood circulating in your circulatory system at any given time)

When these things increase, your heart and blood vessels come under great stress, which means hemodynamic stress. For example, the blood volume increases by 50%, which may not be managed by the LVAD device.

Thrombotic Events:

Pregnancy increases the risk of blood clot formation, and for someone who is dealing with an LVAD device, it becomes even more risky. When the blood clot forms, it can damage the LVAD pump, organs, and often lead to conditions like stroke. And you know the worst thing? You cannot even take blood thinner pills, as they are prohibited in pregnancy.

Medication-associated Deformities:

Another major concern? Blood thinner medications that LVAD patients must use for the rest of their lives. These medications become risky for both the mother and baby during pregnancy. In a baby, it can cause developmental issues and retarded growth, whereas in a mother, it increases the risk of bleeding.

Uterine Impingement:

As pregnancy progresses, the uterus will expand, which can create a challenge for women with an LVAD. The growing uterus may press against internal components of the LVAD device. This is known as uterine impingement, and it can interfere with blood flow or affect the positioning of the device. 

Limited evidence-based practice:

Accept the fact that only a number of obstetricians and cardiologists have managed a pregnancy that involved an LVAD. So, we need more clinical guidelines and research that support the management and care for pregnancy with an LVAD.

Signs of heart problems during pregnancy:

A pregnant woman, in general, may face the following:

• Fatigue
• Increased frequency of urination
• Swelling 
• Shortness of Breath

But when you know you are having an LVAD, you need to be cautious. There is a problem when you notice any of the following:

• The symptoms mentioned above usually appear late in pregnancy, but when they occur in the early phase, they may need close observation.
• You are not able to perform even the simplest daily tasks.
• Chest pain during pregnancy or discomfort is considered an emergency.
• Fainting
• Changes in vision

You must be extra cautious, as a single wrong step may lead to serious complications.

How can you manage pregnancy after an LVAD?

While we are dealing with a matter that is extra sensitive and has limited clinical guidelines, we can still try to cover this journey with rare challenges. Just take one thoughtful step at a time and be cautious for your heart, your baby, and your well-being.

Role of a Multidisciplinary Team:

You will need more than just one doctor. Make your professional team get you through this journey. For example, your cardiologist will take care of your heart, the LVAD specialist will handle the device and its complications, a gynecologist or obstetrician to take care of pregnancy, and other disciplinary team members if necessary. 

Eat Mindfully:

You need to take a diet that supports your health and provides complete nutrition that is necessary for the development of your baby. Also, learn from A Guide to Better Heart Health, so that you can support your heart in every way possible.

Manage stress effectively: 

Pregnancy is something that is emotionally very challenging, and when you have an LVAD, it will be a lot to handle. Practice deep breathing exercises and engage in healthy conversations to relax your mind. 

Engage in safe levels of activity:

When we say a safe level of activity, it means just a simple walk, and exercises approved by your doctor. Moderate and high-intensity exercises can put your heart under strain, so they should be avoided. 

Manage Weight:

Maintaining your weight means gaining only the safe amount of weight during pregnancy to protect your heart and baby. 

LVAD gear helps you manage your routine during pregnancy:

During pregnancy, even a minor support makes you comfortable, and having something that can carry your LVAD device safely without discomfort is something you definitely don’t want to miss. LVAD vests and LVAD belts are going to make your everyday life easier.

Documented Case Study of Pregnancy after LVAD:

There have been a few rare cases of women getting pregnant with an LVAD, some unintentionally, others with great determination. These cases are extremely high-risk and require the constant attention of a multidisciplinary medical team. 

Pregnancy with an LVAD might sound nearly impossible, but it has happened. A recent review looked at 10 reported cases and found that 8 women were able to deliver successfully, while 2 experienced serious complications. The journey is not easy, and the situation makes it a high-stakes situation for both mother and baby. The Ultimate? It is rare and risky, but with the right support, medical help, and multidisciplinary approach, it is not out of the question.

Final Thoughts:

Pregnancy with an LVAD is not something easy to manage, and it requires a thoughtful approach and expert guidance. While the journey may be filled with challenges, it is important for you to stay informed and connected with your healthcare team. Ultimately, every decision should prioritize both your well-being and that of your future little one.

FAQs

Can pregnancy cause heart failure?

Pregnancy can lead to various complications, like heart failure, if the heart health is compromised or already has a pre-existing problem with no proper treatment.

What causes heart defects in fetus?

Fetal heart defects can result from genetic factors, infections, medications, or maternal health conditions.

What are the causes of cardiac arrest in a pregnant patient?

Cardiac arrest in pregnancy can be caused by heart failure, embolism, severe bleeding, or complications related to anesthesia.

What are some of the side effects of increased blood volume during pregnancy?

Increased blood volume can cause swelling, high blood pressure, and added stress on the heart.