Getting Pregnant With Congenital Heart Disease
Posted 5/22/2017 by UHBlog
Doctors used to discourage women with congenital heart lesions from getting pregnant. But now, they're giving many of these women the green light to start families.
An American Heart Association report issued earlier this year reveals pregnancy success rates – meaning both mother and child are healthy following delivery – for women with congenital heart disease can be nearly identical to those for women with healthy hearts. This is true when women with heart issues:
- Seek pre-pregnancy counseling from a cardiologist and high-risk obstetrician
- Plan for any contingency during delivery, such as having medical specialists or specialized equipment in the delivery room
- Receive post-pregnancy monitoring
However, women with Eisenmenger syndrome and some aortic conditions are still cautioned against pregnancy.
Why the about-face?
“People are living much longer after congenital heart repairs,” says maternal fetal medicine expert Ellie Ragsdale, MD. “The heart is more functional following repairs, so people are living into adulthood – and they want to start families.”
There’s also a recognition that some women have become pregnant and given birth successfully, even after their doctors advised them to avoid pregnancy, says pediatric cardiologist Christopher Snyder, MD.
“One report says 50 percent of women who were told they shouldn’t have babies, had babies,” he says. “Often, those babies are perfectly normal. Or, the babies may have the same (condition) as the moms do, but the mothers say, ‘I’m fine with this.’”
Dr. Snyder says discussions about pregnancy sometimes begin with parents following the birth of a female diagnosed with congenital heart disease.
“We talk to families about what this may mean for their child’s children,” he says. “Then at age 14 or 16, we talk to (the girl) about her likelihood of having children with this disorder. The (potential) mom has to be prepared, and the heart has to be ready to have a child because pregnancy means a lot more volume for the heart to pump.”
A baby’s chance of developing congenital heart disease is just 0.8 percent if neither parent is afflicted. It rises to 3 – 6 percent if one parent has the condition, especially if that parent is the mother.
According to Dr. Ragsdale and Dr. Snyder, females with congenital heart disease should take these precautions on their path to motherhood:
- Get in good physical shape before conceiving. Weight, blood pressure and cholesterol should be well-controlled.
- Consult a high-risk obstetrician and pediatric cardiologist, preferably before conceiving, but, if not, immediately upon confirming pregnancy. “Being open and honest about lifestyle habits and medications – whether they're over-the-counter or illicit drugs – will allow the best chance of a successful pregnancy,” Dr. Ragsdale says. “Planning ahead and seeing a doctor six months to a year before wanting to get pregnant is the smartest course of action.”
The doctor may order an echocardiogram or a cardiac MRI to ensure the woman's heart is healthy enough to withstand pregnancy and delivery.
- Undergo an echocardiogram at least once a trimester. If needed, medications can be prescribed to lessen the strain on the mother's heart and increase her chances for a safe delivery.
- Get a fetal echocardiogram early in the second trimester. It's important for the parents and physicians to know whether the fetus has a structural heart disease, so they can prepare families for what lies ahead or take immediate measures to control the situation.
“Often, there are things we can do to help the fetus so the mom can deliver at term and the baby can be much healthier,” Dr. Snyder says, adding that a team of UH doctors recently performed an in vitro procedure on a fetus with severe aortic stenosis.
- Plan for all contingencies. “We usually recommend delivery at a major institution with 24-hour access to pediatric cardiac care and evaluation,” Dr. Ragsdale says.
Depending on the situation, the plan may include having cardiologists for the mother and baby in the delivery room.
- Continue monitoring after pregnancy. Doctors want to ensure the mother's heart remains healthy following delivery, or take steps to strengthen her heart, if needed.
Ellie Ragsdale, MD,is a maternal and fetal medicine expert, Obstetrics and Gynecology, at University Hospitals Cleveland Medical Center. You can request an appointment with Dr. Ragsdale or any other doctor online.
Christopher Snyder, MD, is the division chief, Pediatric Cardiology, at University Hospitals Rainbow Babies & Children’s Hospital and University Hospitals Cleveland Medical Center. You can request an appointment with Dr. Snyder or any other doctor online.