There is a common misconception that women with heart disease should avoid pregnancy entirely. However, with proper planning and accurate information, they can experience a safe and healthy pregnancy. Regular medical follow-ups, adherence to prescribed precautions, and careful planning can make the pregnancy journey smooth and uneventful.
How Pregnancy Affects Your Heart
During pregnancy, your heart works significantly harder as it needs to pump 40% more blood to supply all body organs. This increased workload leads to certain physiological changes:
– Dilation of Blood Vessels: To accommodate the increased blood flow, blood vessels expand, which lowers blood pressure.
– Thicker Blood: Blood becomes more prone to clotting, a natural mechanism to prevent excessive bleeding during childbirth.
While a healthy heart can adapt to these changes seamlessly, women with pre-existing heart conditions face additional strain on their heart. Therefore, careful evaluation and monitoring before conception are essential for a safe pregnancy journey.
What Should Be Done If a Heart Patient Becomes Pregnant?
Certain congenital heart conditions can affect women of childbearing age. Proper diagnosis, management, and medical supervision are crucial to ensure a safe pregnancy.
Shunt Lesions
Shunt lesions involve abnormal blood flow caused by holes between the heart chambers. Common types include:
- Atrial Septal Defect (ASD): A hole between the upper chambers of the heart.
- Ventricular Septal Defect (VSD): A hole between the lower chambers of the heart.
- Patent Ductus Arteriosus (PDA): Abnormal blood flow between the aorta and the pulmonary artery.
If the hole is large, significant blood flow from the left side of the heart can return to the right side, increasing pressure on the lungs and straining the heart. This can lead to:
- Enlarged heart
- Irregular heart rhythms
- Pulmonary hypertension (increased pressure in the lungs)
Severe pulmonary hypertension can reverse blood flow across the shunt, resulting in Eisenmenger syndrom, which causes low oxygen levels in the blood (cyanosis).
Obstructive Lesions
Obstructive lesions limit blood flow to the heart and its major blood vessels. One such condition is coarctation of the aorta, where the descending aorta (the body’s largest artery) narrows. This can lead to:
- High blood pressure in pregnant women
- Reduced blood flow to the placenta, which can affect the fetus
Management:
Depending on the severity, a procedure may be required before or during pregnancy (preferably in the second trimester) to ensure both maternal and fetal health.
Complex Lesions
Certain complex heart defects, if left uncorrected, can worsen during pregnancy. Examples include:
1. Transposition of the Great Vessels: Without correction, this can lead to heart failure, leaky valves, and worsening symptoms during pregnancy.
2. Tetralogy of Fallot: This condition, which includes a ventricular septal defect (VSD), narrowing of the pulmonary valve, abnormal aortic configuration, and cyanosis, can cause:
- Heart failure
- Arrhythmias
Management:
Correction before pregnancy is essential to reduce complications.
General Considerations for Women with Congenital Heart Defects
Women with congenital heart defects, especially those who have had corrective surgery, can generally have a safe pregnancy. However, the outcome depends on:
- The type and severity of the defect
- The presence of heart muscle dysfunction, rhythm disorders, or pulmonary hypertension
A cardiologist should assess individual risks and provide appropriate management during pregnancy.
Valve Disease & Pregnancy
- Rheumatic Heart Disease
Conditions like aortic stenosis (narrowing of the aortic valve) and mitral stenosis (narrowing of the mitral valve) make the heart work harder to pump blood, which can lead to left ventricle hypertrophy (enlargement).
- Bicuspid Aortic Valve
This congenital condition, where the aortic valve has only two leaflets instead of three, can lead to aortic stenosis.
Pregnancy Complications
During pregnancy, increased blood volume and heart rate can worsen mitral stenosis symptoms, causing:
– Left atrium enlargement
– Irregular heart rhythm (atrial fibrillation)
– Increased risk of stroke
If symptoms become severe, balloon valvuloplasty (PTMC) may be performed during the second trimester, the safest time for the procedure.
Pregnancy in Women with a Prosthetic Valve
Women with a prosthetic valve face additional risks during pregnancy, primarily due to lifelong use of blood thinners and anticoagulants, which can affect the baby.
Management:
– First Trimester: Heparin or low molecular weight heparin
– Up to 36 Weeks: Warfarin
– After 36 Weeks: Heparin or low molecular weight heparin again until delivery
It is crucial to consult a cardiologist before pregnancy to tailor the best anticoagulant therapy.
Arrhythmias and Pregnancy
Abnormal heart rhythms (arrhythmias) are common during pregnancy. Most are benign, but some may signal a serious underlying condition that is detected only during pregnancy. In all cases, it is important to:
- Consult a cardiologist
- Undergo necessary tests and evaluations
Heart Conditions Where Pregnancy Should Be Avoided:
- History of Peripartum Cardiomyopathy in previous pregnancies
- Eisenmenger Syndrome (High pulmonary artery pressure and reversal of blood flow from right heart to left heart)
- Severe Left Ventricular Dysfunction (Weak heart muscle)
- Severe Mitral Stenosis
- Severe Pulmonary Hypertension
- Uncontrolled Blood Pressure or Diabetes
Precautions for Heart Patients during Pregnancy:
– Restrict salt and excessive water intake
– Avoid certain drugs, including painkillers and blood pressure medications like ACE inhibitors, ARBs, and ARNi
– Take heart medications as prescribed by your doctor
– Regular follow-ups and investigations to monitor heart health throughout pregnancy
