Article Text

Download PDFPDF

Pregnancy during cardiology training: a call to action
  1. Sarah M Birkhoelzer1,
  2. Francis J E Gardner2,
  3. Rebecca F Ortega3,
  4. Roxana Mehran4
  1. 1 Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
  2. 2 Gynaecology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
  3. 3 Women as One, Charlotte, North Carolina, USA
  4. 4 Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Sarah M Birkhoelzer, Cardiology, Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK; Sarah.birkhoelzer{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

The pregnant cardiologist

In the UK, 28% of cardiology trainees and 13% of cardiologists post completion of training are women; in the USA they represent 20% and 12%, respectively.1 2 The years spent in training and early practice represent women’s prime childbearing years. Competing demands on female trainees might be the reason why many women do not choose cardiology.3 What, therefore, are effective ways to negotiate these issues and not lose talent in cardiology?

Concerns regarding pregnancy during cardiology training

During pregnancy, a wide spectrum of biological and psychological disturbances can impact on the individual’s clinical training performance. These include the impact of fertility treatment, pregnancy symptoms, radiation exposure during pregnancy, shift work, securing maternity leave and childcare (figure 1). Due to the limited number of women in cardiology, those who are pregnant may also feel isolated and unsupported, particularly if they have experienced miscarriages or required fertility treatment.

Figure 1

Concerns of the pregnant cardiologist.

It is important to raise awareness about fertility issues and pregnancy complications which are prevalent among cardiologists (miscarriage, pre-term delivery, pre-eclampsia, gestational diabetes) and often lead to the use of assisted reproductive technology.4 Education of radiation exposure is inconsistent and resources for the pregnant cardiologist are lacking. Both form potential barriers for women to enter cardiology training or develop and maintain interventional skills.5

How can we support pregnant cardiologists?

It is important to acknowledge that transition into parenthood can be overwhelming and results in major physical, emotional and financial challenges. It is vital to minimise psychosocial and environmental stressors which have a negative effect on pregnancy, maternal and fetal health, and can result in long-term health implications.6 Pregnant colleagues should be encouraged to attend medical appointments regardless of potential service commitment. The Cardiology training programme can be intense at times without superimposed challenges of a pregnancy.7 It is important to facilitate well-being of the pregnant women and their unborn child in order for them to deliver quality care to their patients. Women have different experiences during pregnancy, and it is inappropriate to expect all of them to perform normal duties including shift work and procedural activities. It is essential that employers incorporate parental responsibilities into workforce planning and offer flexible training to avoid undue pressures on pregnant women and parents.6 Returning to work should be treated as a process and adjustments like flexible work schedules should be facilitated to encourage return to work while accommodating childcare responsibilities. The work schedule and requirements of working parents should be communicated to colleagues to avoid false expectations and allow a supportive environment. In addition, dedicated space for nursing mothers to express milk is necessary at the workplace and conferences. Part time schedules might be required due to caring responsibilities for children or ageing parents, academic commitments, extra-curricular activity like sports or for health reasons. Although currently the majority of part time trainees are women, it is critically important to support men who wish to work flexibly for the same reason.8

Supporting resources

Social media-based initiatives like ‘Global Women In Cardiology (WIC)—Early Career’ and professional organisations such as the British Junior Cardiologists’ Association (BJCA) in the UK and the WIC Section of the American College of Cardiology (ACC) in North America, as well as the independent, non-profit organisation Women as One have been vocal on these issues, proactively developing educational resources to better support the pregnant cardiologist.

The BJCA WIC and Flexible training representative set up a pilot mentorship programme for female cardiologists in training to support their personal and professional well-being. In addition, a support group for female cardiologists was formed to share experiences and raise awareness about concerns related to motherhood. The WIC section of the ACC frequently publishes on these topics and offers networking events, professional development and mentoring programmes. Women as One supports family planning, pregnancy, parental leave and return to work practices through educational efforts. Women as One also offers comprehensive information on radiation safety for the pregnant cardiologist on their website. A global parenting survey has also been performed to inform targeted projects supporting Cardiology as a family-friendly specialty.

The skills of a working parent such as multitasking, conflict resolution, time management and prioritisation are valuable transferrable competencies to the professional life of a cardiologist. Increasing numbers of female role models emerge in all subspecialities of cardiology refuting the misconception that motherhood and cardiology cannot be combined. Hopefully this, along with the increasing prevalence of flexible working schedules, will help remove barriers to pregnancy during cardiology training.



  • Twitter @birkhoelzerS

  • Contributors All authors equally devised the manuscript, created and revised drafts, performed independent literature reviews and agreed on the content of the finalised and revised manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.