Yes, you can safely get an echocardiogram while pregnant. The test uses sound waves, not radiation, to create images of your heart. It poses no known risk to you or your baby and is the preferred method for evaluating heart concerns during pregnancy.
Why Echocardiograms Are Safe in Pregnancy
An echocardiogram works the same way as the ultrasound you get at prenatal checkups. A technician places a handheld probe on your chest, and it bounces sound waves off your heart to produce a moving picture on a screen. There are no X-rays, no contrast dyes (for the standard version), and no needles involved. The American Institute of Ultrasound in Medicine states there is insufficient evidence to conclude that diagnostic ultrasound causes adverse effects in humans. Because it avoids ionizing radiation entirely, an echocardiogram is considered the go-to cardiac imaging tool for pregnant patients.
Why Your Doctor Might Order One
The most common reason for a maternal echocardiogram during pregnancy is new cardiac symptoms, accounting for about 35% of referrals. That includes shortness of breath that goes beyond what’s typical for pregnancy, chest pain, a racing or irregular heartbeat, unusual swelling, or fainting episodes. Pregnancy increases your blood volume by roughly 50%, so your heart works harder than usual. Sometimes that extra workload unmasks a heart issue that was previously silent.
A history of heart disease is the strongest predictor that the echocardiogram will find something abnormal, with about 2.6 times the odds compared to patients without that history. Other factors linked to abnormal findings include tobacco use, having had multiple pregnancies, and being in the postpartum period. If you have a pre-existing condition like a repaired valve, a congenital heart defect, or high blood pressure, your cardiologist or maternal-fetal medicine specialist may schedule echocardiograms at several points during your pregnancy to track how your heart is handling the increased workload.
What the Test Looks Like for Pregnant Patients
A standard transthoracic echocardiogram takes less than an hour, requires no fasting, and needs no special preparation. You’ll change into a hospital gown from the waist up, and a sonographer will apply gel to your chest before moving the probe across several positions to capture different views of your heart.
The one difference during pregnancy is positioning. After about 20 weeks, lying flat on your back can cause the weight of your uterus to press on a major vein called the inferior vena cava, which returns blood from your lower body to your heart. That compression can drop your blood pressure and make you feel lightheaded or dizzy. To avoid this, the sonographer will typically have you lie on your left side, sometimes propped with a wedge or pillow. By the third trimester, your heart has also shifted upward and slightly to the left as the uterus grows, but a trained sonographer adjusts the probe placement to account for this.
What Doctors Are Looking For
Pregnancy changes how your heart looks on an echocardiogram even when everything is healthy. Your heart chambers get slightly larger, your heart pumps more blood per beat, and a small amount of valve leakage that wouldn’t exist outside of pregnancy can appear. Cardiologists who read echocardiograms in pregnant patients know to interpret these findings as normal adaptations rather than signs of disease.
The more serious condition an echocardiogram can catch is peripartum cardiomyopathy, a form of heart failure that develops during the final month of pregnancy or in the months after delivery. It’s diagnosed when the heart’s pumping efficiency, measured as ejection fraction, drops below 45% (normal is 55% or higher) and no other cause explains the decline. Symptoms like severe breathlessness, swelling in the legs and feet, and an inability to lie flat can overlap with normal late-pregnancy discomfort, which is why the echocardiogram is so valuable. It gives a direct, real-time look at how well your heart muscle is contracting. Early detection matters because treatment can begin sooner and outcomes improve significantly.
Maternal Echo vs. Fetal Echo
It’s easy to confuse a maternal echocardiogram with a fetal echocardiogram, but they serve completely different purposes. A maternal echo examines your heart. A fetal echo examines your baby’s heart while still in the womb. The fetal version is typically performed between 18 and 22 weeks of pregnancy, and the probe is placed on your belly rather than your chest. It’s interpreted by a pediatric cardiologist who specializes in congenital heart defects.
A fetal echocardiogram is recommended when there’s an elevated risk of a heart defect in the baby, for example, if either parent has a congenital heart condition, if a routine prenatal ultrasound flagged a concern, or if there’s a strong family history. The test can identify structural problems with the baby’s heart and detect abnormal heart rhythms. A limited look at the fetal heart happens during standard obstetric ultrasounds, but the dedicated fetal echo provides a far more detailed evaluation.
Transesophageal Echo During Pregnancy
In rare cases, your doctor may recommend a transesophageal echocardiogram instead of the standard chest-wall version. This involves passing a thin, flexible tube with a tiny ultrasound probe down your throat to get closer images of the heart from behind. It’s used when the standard approach doesn’t provide clear enough images or when a specific structure, like a heart valve or the lining around the heart, needs a closer look. You’ll be asked not to eat or drink for several hours beforehand, and you’ll receive mild sedation. While this type is less common during pregnancy, it can still be performed when the clinical need justifies it. Your care team will choose sedation medications that are considered safe for pregnancy.