|
 The guidelines are the first from the American Heart Association to
offer a road map to women with congenital heart defects who have
long been told to avoid pregnancy altogether, said Mary Canobbio, a
researcher at the University of California, Los Angeles and chair of
the committee that drafted the advice.
“Historically the tendency has been to advise these women to avoid
pregnancy because the defect and surgeries done to keep these women
alive are complex and the long term survival is difficult to predict
– so concern has been that the ‘added burden’ of pregnancy could
potentially cause more problems and decrease their own long term
survival,” Canobbio said by email.
Congenital heart defects such as defective vessels, leaky valves or
holes in the heart muscle are among the most common types of birth
defects. These structural problems can cause symptoms like abnormal
heart rhythm and breathing difficulties and may require surgery or a
heart transplant.
While most girls born today with congenital heart disease will reach
childbearing age, pregnancy carries a risk of complications for both
these mothers and their babies.
One concern is that women’s blood volume increases by 50 percent
during pregnancy to help support her growing baby. That means the
mother’s heart must be able to handle the additional burden,
Canobbio said.
Hormonal changes during pregnancy can also increase the risk of
irregular heart rhythm and blood clotting. In healthy women these
changes aren’t usually a problem, but in women with structural heart
damage this can increase their risk of stroke, Canobbio added.
Pre-pregnancy counseling is essential for women with complex
congenital heart defects so that they have a clear understanding of
how their heart abnormalities could affect both their own health and
the health of their child during a pregnancy, the new guidelines
advise.
For some structural heart problems, and women with a family history
of these problems dating back several generations, genetic screening
before conception can help estimate the odds that women may pass
heart defects on to their children.
Once pregnant, a delivery plan is also essential, so the medical
team can anticipate problems that could happen during and following
delivery and be prepared.
Ideally, women should deliver their babies at medical centers that
have a cardiologist experienced in managing complex congenital heart
disease, obstetricians trained in high-risk maternal-fetal medicine,
cardiac anesthesia and a cardiac surgical team.
[to top of second column] |
After delivery, women need monitoring for up to six months because
the effects of pregnancy can linger that long, the guidelines also
note.
The scientific statement, published in Circulation, will likely set
a new standard of prenatal, delivery and postpartum care for women
with congenital heart defects because this marks the first time a
leading U.S. cardiology group has weighed in, said Dr. Wayne
Franklin, medical director of the adult congenital heart disease
program at Texas Children’s Hospital in Houston.
“The take-home message here is that women should talk to their
cardiologist, and also obtain preconception counseling with a
maternal-fetal-medicine specialist, if they have a heart problem but
are considering pregnancy,” Franklin, a researcher in obstetrics and
cardiology who wasn’t involved in the guidelines, said by email.
That’s because normal changes in blood volume, heart rate and blood
pressure that happen in every pregnancy can adversely affect women
with congenital heart disease, Franklin said.
And, mothers with congenital heart disease have an 8- to 10-fold
increase in the chance of their baby having a congenital heart
defect, Franklin added. With close monitoring, many problems in
developing infants can be detected before infants are born.
“We now know that with close collaboration with a multi-disciplinary
team, we can achieve excellent outcomes for both the mother and
baby,” Franklin said.
SOURCE: http://bit.ly/2jy5dAO Circulation, online January 10, 2017.
[© 2017 Thomson Reuters. All rights
reserved.] Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed. |
