The month of February is used by some countries to bring greater awareness to diseases of the heart and to promote healthy heart lifestyles. There is growing evidence that more women with heart diseases are getting pregnant – and an estimated 1% to 4% of pregnancies have cardiovascular disease, with congenital heart disease (CHD) being the most common preexisting condition and hypertension the most common acquired condition.
What is the heart disease?
Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina) or stroke. Other heart conditions, such as those that affect your heart’s muscle, valves or rhythm, are also considered forms of heart disease.
Given the potential complications associated with maternal cardiovascular disease, it is very important that women with heart disease should receive counselling prior to becoming pregnant – and they should be managed appropriately during the pregnancy, labour and delivery. The complexity of these patients requires a multidisciplinary approach with the involvement of obstetricians, cardiologists, anesthetists, and internists who are experienced in caring for such patients.
How does pregnancy affect the heart?
Pregnancy stresses the heart and circulatory system. During pregnancy, the blood volume increases by 30 to 50 percent to nourish the growing fetus. The amount of blood the heart pumps each minute also increases by 30 to 50 percent. The heart rate increases as well. All these changes result in the heart working harder during pregnancy. Labour and delivery also add to the heart’s workload.
What are the risks of a pregnant woman with heart disease?
There is no doubt that heart disease increases the risks of various complications during pregnancy. These complications can affect the pregnant woman and her offspring. These risks will vary depending on several factors.
The risks also depend on the nature and severity of the underlying heart condition. Minor abnormalities in heart rhythm are common during pregnancy and usually cause very few problems. If you have an artificial heart valve or your heart or valves are scarred or malformed, you might face an increased risk of complications during pregnancy.
In addition, artificial or abnormal valves carry an increased risk of endocarditis — a potentially life-threatening infection of the lining of the heart and heart valves.
Women with congestive heart failure might find that their condition gets worse during pregnancy.
If a pregnant woman was born with a heart problem, her baby has a greater risk of developing some type of heart defect.
The risk of pregnancy in women who have the rare congenital condition Eisenmenger’s syndrome, or high blood pressure that affects the arteries in the lungs and the right side of the heart (pulmonary hypertension), is so high that pregnancy is not recommended.
Heart medication during pregnancy?
Many women often ask me whether it is safe to use their heart medication during pregnancy. The answer is often yes, but this is a question that should be discussed by the woman and her physician prior to conception.
Any medication a pregnant woman takes during pregnancy can affect her baby. As far as heart disease and medications, often the benefits outweigh the risks. If you need medication to control your heart condition, your healthcare provider will often prescribe the safest medication at the most appropriate dose.
Women are encouraged to take their medication exactly as prescribed and do not stop taking the mediation or adjust the dosage on their own. Always talk to the doctor first.
What you should do prior to becoming pregnant?
I often advice women with heart disease to see their doctor before trying to conceive. They should schedule an appointment with their cardiologist and their gynaecologist/obstetrician who will be handling their pregnancy. This medical team will evaluate how well the woman is managing her heart condition and consider any treatment changes that might be needed before pregnancy begins.
It should be pointed out that a few medications commonly used to treat heart conditions are not used during pregnancy. Depending on the circumstances, the healthcare provider might adjust the dosage or make a substitution and explain the risks involved.
Antenatal or prenatal visits
All pregnant women with heart disease are considered high risk pregnancies and will need to see their healthcare provider more frequently than usual – and more tests might be needed. Your healthcare provider might use various tests, such as an echocardiogram and electrocardiogram, to evaluate your heart function.
Your obstetrician will closely monitor the baby’s development throughout the pregnancy. Routine ultrasound exams can be used to track the baby’s growth, and specialized ultrasounds can be used to detect any fetal heart abnormalities.
Signs and symptoms to be concerned about
If you have any of the following signs or symptoms, you should get in contact with an experienced healthcare provider:
• Shortness of breath with exertion
• Difficulty breathing at any time
• Heart palpitations, rapid heart rate or irregular pulse
• Chest pain
• A bloody cough or coughing at night
Labour and delivery
Your healthcare team will help you decide about various options during labour and delivery. Your healthcare provider might recommend delivering your baby at a medical center that specializes in high-risk pregnancies. If there are concerns about your heart, you might need to have certain specialists present, such as a cardiologist and anaesthetist and a paediatrician, during labour and delivery.
What about breastfeeding?
Breast-feeding is encouraged for most women who have heart conditions, even those who take medication.
If you have a congenital heart problem that greatly increases your risk of endocarditis, your doctor will probably discuss the risk of mastitis while breast-feeding.
Conclusion
More women with heart disease are now becoming pregnant and having successful pregnancies. It must be noted that women with heart disease who become pregnant are at an increased risk for various complications during pregnancies. These women should be monitored closely during their pregnancies. Women with heart disease who are thinking about conceiving should ideally have pre-pregnancy counselling and see their healthcare provider prior to pregnancy.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
