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Home > Our Services > Conditions and Treatments > Adult Congenital Cardiac Patients (and Pregnancy)

Adult Congenital Cardiac Patients (and Pregnancy)

 

 


 

What is it?

 

Heart disease in pregnancy is a rare condition but can carry with it significant risks to the mother and fetus.

 

The prevalence of this condition is found in approximately one to five percent of pregnant women. The most common cardiac conditions range from congenital heart defects like mitral valve prolapse (a disorder in which the heart's mitral valve billows out and does not close properly) to rheumatic heart disease.

 

With advances in surgical methods, more females will survive their conditions to reach child bearing age. As such, the incidences of pregnant women with cardiac conditions are on the rise. Problems like pulmonary hypertension (high pressure in the lung) , Marfan syndrome (an inheritable disorder of connective tissue affection the cardiovascular system) and cyanotic congenital heart disease (congenital heart defects resulting in low oxygen levels in the blood) form the highest risk group.

 

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Monitoring the Heart Condition

 

Symptoms like palpitations (due to abnormal heart rhythms), leg swelling, and breathlessness present in normal women may also worsen in pregnancy.  From the 28 to 32 weeks of gestation, the effect of pregnancy on heart is the greatest and patients with valvular disorders (e.g. mitral stenosis), pulmonary hypertension, or cardiomyopathy (weak heart function) may find a sudden deterioration in their condition. Close monitoring of these patients are needed in pregnancy.

 

Pregnant women may be at increased risk of thromboembolism (complications caused by the formation of blood clots) due to hormonal effects, enlarging uterus and reduced mobility. This may present with swelling and pain in the calf (caused by venous blood clots).  Some of these conditions may need treatment with blood thinning drugs (e.g. warfarin)  which can cause fetal abnormalities depending on the stage of gestation.

 

Female patients with a congenital heart defect carry a 2.5% to 18% risk of having a child with congenital heart disease, ranging from a simple lesion to a very complicated heart abnormality. Some rate genetic abnormalities have a 50% risk of transmission to the next generation (e.g. Marfan Syndrome , 22Q11 deletion syndrome). Thus genetic counseling of the patient and spouse should take place before conception.

 

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How do I know if I am healthy enough to get pregnant?

 

Everyone's situation is different, and you need advice based on your specific conditions, previous history, and present status. An up-to-date assessment should be done before planning a pregnancy. This will often include testing specific to your condition. If you become pregnant before such an assessment, it should be arranged as soon as possible.

 

Many women with congenital heart conditions and surgical repairs have had children. The risk of pregnancy will depend on the specific cardiac condition.

  • With appropriate assessment and care, the pregnancy outlook for women with heart disease is generally favorable.
  • Some medications should not be taken during pregnancy (e.g. high blood pressure medications ACE inhibitors) , so early review  of your medications is needed. Some medications, like Folic acid should be taken early in pregnancy to reduce the incidence of birth defects.
  • If you require more surgery for your heart condition in the near future, it is wise to consider the timing of this in relation to pregnancy. Sometimes, the surgical procedure should be done first, as this may increase the probability of a successful pregnancy without cardiac complications.
  • More often than not your condition will be low risk, and you may be reassured that little or no specialized care is required.

 

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Will my child have a congenital heart problem?

 

Some heart conditions can be passed on from a parent to his or her child. The risk depends on what condition you have and whether your family members are affected. Your cardiologist can help to determine your risk, and can also refer you to a clinical geneticist for counseling, if appropriate.

 

When the mother or father has a congenital heart defect, one can screen for major fetal congenital heart defects by performing a fetal echocardiography. This test is helpful as it allows early planning for the baby's care after delivery and reassurance to parents if it is normal.

 

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If I have a child already, how would I know if he/she has a heart defect?

 

Heart defects in children do not always occur in an identical form to those of their parents. They may be more severe, the same or milder than their parents. All children of parents with a congenital heart defect should be examined by a pediatrician soon after birth. Occasionally an echocardiogram is indicated if the examination is abnormal.

 

This should be discussed with your Pediatrician who can make the appropriate arrangements for your child to be screened. Your Cardiologist may also be able to help. Screening should be done again after the child is two months old, as evidence for some cardiac defects will not show up until that time.

 

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What are the effects of pregnancy on the heart?

 

In pregnancy, there are increased demands created by the fetus as well as the hormonal changes brought about by the pregnancy. This causes a significant increase in the amount of blood pumped out of the heart (cardiac output). At rest, cardiac output will increase by 50% from 4L/minute to 6L/minute in early pregnancy. During labour, the cardiac output may rise further due to pain and exertion and decreases by within two weeks after delivery. As such, problems like palpitations (sensation of fast beating heart) and high blood pressure are common during pregnancy. These problems, if untreated, may lead to maternal and fetal complications. Up to eight percent of normal gestations may be affected by hypertensive disorders in pregnancy. Some patients with congenital heart defects may be diagnosed for the first time due to the hemo-dynamic stresses of pregnancy.

 

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Adult Congenital Heart Disease Programme

 

The National University Hospital hosts a specialised cardiac clinic for pregnant women with heart disease. Our team of doctors with special interest in pregnancy in heart disease comprises :

 

Cardiologist:

Primary physician in charge: A/Prof James Yip, Senior Consultant

For appointments, please call (65) 6772 2092

 

Obstetrician:

Private Consultation:

A/Prof Arijit Biswas, Senior Consultant, Obstetrics and Gynaecology

A/Prof Mary Rauff, Senior Consultant, Obstetrics and Gynaecology

A/Prof Y C Wong, Senior Consultant, Obstetrics and Gynaecology

Dr Mahesh Choolani, Consultant, Obstetrics and Gynaecology

For appointments, please call (65) 6772 2255 / 2277

 

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