Congenital Heart Defects and Pregnancy
Why are Congenital Heart Defects (CHDs) an issue?
The chances of reaching adulthood for most girls who are born with Congenital Heart Disease (CHD) are higher today. Although many women are capable of becoming pregnant, women with a moderately complex or complex CHD might have a higher risk throughout pregnancy to have complications. The risks of complications are both for the fetus and the mother.
When doctors evaluate pregnant women in the beginning of pregnancy, they will want to measure the oxygen levels in the blood and measure the woman’s heartbeat. They will also likely take an ultrasound of the heart to produce a visual display of the heartbeat.
In pregnant women, blood will have a chance to coagulate (clot), throughout the pregnancy. Since every pregnancy is individualized, the type of anticoagulant (a blood thinner) that might be used will depend on the needs of the woman.
History and Heredity
The doctor will want to know if there has been any procedure or surgery done to the heart, including palliative care (treating rather than curing the problem) and anything to help repair the heart.
A family history can play a huge role in the pregnancy. Knowing the family history in the past three generations can help determine to what extend a CHD might be passed down to the next generation. Knowing the complete family health history might also be helpful for the physician during a pregnancy.
We focus on pregnant women with a CHD for several reasons. Utah has the youngest adult population and the highest birth rate in the US. This makes Utah ideal for assessing this extremely vulnerable population that has not been studied thoroughly.
Between 2008 and 2013, Utah women had a 30% higher rate of fertility compared to the average in the United States. The fertility rate measures the average number of children that a woman has over her lifetime per 1,000 women. Approximately 325,000 pregnancies took place during this time period. We do not know the number of pregnant women with a CHD living in Utah; making this an important goal of this project.
Why do I need specialized care?
Women should talk to their obstetric care provider and also an Adult Congenital Cardiology specialist prior to becoming pregnant. Talking to your doctor about treatment can increase the chance of having a healthier pregnancy.
For any woman with a mechanical valve, the American College of Cardiology or the American Heart Association recommends a pre-pregnancy counseling session with a cardiologist who is an expert in valvular heart disease and pregnancy.
The health issue during pregnancy may be higher or lower, depending on the type of CHD along with the woman’s clinical status. Talking to a physician regarding contraception and any issues with pregnancy can help a woman assess the risks involved with a pregnancy.
The risks to both the mother and baby before pregnancy should be reviewed in detail. Another aspect that should be reviewed is an anticoagulation strategy (a strategy to make sure the blood doesn’t become a clot). If needed, blood thinners can be used to prevent blood from coagulating during pregnancy.
Counseling before pregnancy is particularly important if a woman is at risk of developing heart failure during the pregnancy.
Many women with CHD are capable of carrying out a pregnancy successfully. Even though there are risks associated with pregnancy, due to the nature of the heart disease, seeking a physician is recommended.
Physicians treating women with a CHD should be up to date with information and should refer women with a CHD to a regional center that has the expertise needed to help a pregnant woman with CHD.
Physicians will want to know a woman’s health and heart history, including any health condition that can have an impact on the pregnancy and treatment.
An early pregnancy evaluation should be done at a regional adult CHD center. This evaluation can establish a plan for prenatal care and management.
Care Throughout Pregnancy
During the third trimester, it is recommended that women get another evaluation to see how the pregnancy and fetus are doing and to see what the best options are for delivery.
If a woman is considered a low risk patient, delivery at a local hospital may be possible. For those women who have had a repair of their heart through surgery and are at low risk, pregnancy can often progress smoothly, especially if the woman has been able to exercise regularly prior to pregnancy. Women considered low risk should still have regular prenatal examinations by their obstetric care provide and a cardiologist specializing in the care of women with a CHD to make sure the woman and fetus remain healthy.throughout the pregnancy. Testing during pregnancy will likely be different and specific for each woman based on her CHD and overall health.
If a woman is considered a high-risk patient, care is best handled through a regional adult CHD center for prenatal care and delivery.
Physicians can also keep track of the pregnancy and any complications related to the CHD throughout the pregnancy.
The Utah Adult Congenital Heart Disease (ACHD) Program offers a complete model of care for taking care of pregnant patients with CHD. Each woman is cared for by a multidisciplinary team, which includes and is not limited to ACHD cardiologists, Maternal Fetal Medicine (MFM) specialists, cardiac anesthesiologists and other specialists as needed.
While in labor and throughout delivery, heart monitoring will take place. Heart monitoring helps women with a history of arrhythmias (heartbeats that are too fast or too slow). Heart monitoring will also occur if a woman has developed an arrhythmia throughout the pregnancy as well.
If there is evidence of cyanosis (poor blood circulation or not having enough oxygen, which turns the skin to a bluish hue) CHD, a team of doctors in multiple specialties will be consulted.
When in labor, it may not be possible to push, as this can be threatening to the woman’s heart. Instead, there will be assistance from the physician and nurses to help the baby out with low forceps. Monitoring of the fetal heart rate will also be continuous.
Where can I go to get care?
Regional centers are a great place to begin the discussion about getting pregnant with a cardiology specialist trained to care for a woman with a CHD.
Every woman with a CHD should
plan for their pregnancy
Talk to a physician who specializes in CHDs
and pregnancy before becoming pregnant
“Making the decision to carry your own child is not one that should be taken lightly whether it is your first pregnancy or you are weighing the risk for additional pregnancies. It is important to remember no two pregnancies are the same.”