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Heart disease and pregnancy
W
hile pregnancy is a beautiful experience
for most expectant parents, it can also be
challenging for women with heart disease,
especially if the pregnancy is unplanned, as it can lead to
possible complications for both the mother and baby.
As a way to help women with heart disease have a
safe pregnancy, Malaysia’s National Heart Institute (IJN),
in collaboration with the Maternal Fetal Medicine unit of
Hospital Tunku Azizah (Women’s Children Hospital Kuala
Lumpur) and the IJN Foundation, has embarked on a
campaign called “Planned Pregnancy, Safer Outcome.”
Dr Geetha Kandavello, Senior Consultant Paediatric
and Adult Congenital Cardiologist at IJN, says the
campaign involves comprehensive and holistic strategies
to improve preconception counselling and antenatal and
postpartum care for pregnant women with heart disease.
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MARCH 2020
“Often, there’s a delay in diagnosis or referral.
Occasionally, the treatment is inadequate or suboptimal,
and this may be due to an unplanned pregnancy,” she
said.
Based on the IJN registries of cardiac and obstetric
clinics, more than 70 percent of women with heart
disease who became pregnant had no preconception
counselling.
According to the Malaysian Confidential Enquiry
into Maternal Deaths (CEMD) data, heart disease in
pregnancy was the leading cause of indirect maternal
deaths in the country between 2009 and 2014,
contributing to up to 50 percent of deaths. One third
of mothers who died had known heart disease prior to
pregnancy.
Dr Geetha adds that heart disease may be diagnosed
in some women for the first time during pregnancy. They
may be coping well in the early stages of pregnancy but
start to develop symptoms and complications as the
pregnancy advances, increasing the risks for both the
mother and baby.
Therefore, women with or at risk of heart disease are
advised to have preconception counselling.
In addition, it’s likely that the number of women in
childbearing age with heart disease is going to increase
in the future, while heart disease may also become more
complicated to treat due to the rising number of children
who have survived congenital heart disease or other
conditions.
For instance, cancer survivors, whose hearts have
been exposed to chemotherapy or radiotherapy, may
not cope well with the normal physiological changes of
pregnancy.
Advanced maternal age and accompanying
conditions such as hypertension, diabetes, high
cholesterol, and obesity are other problems
predisposing women of childbearing age to early heart
disease.
“These women should have a cardiac assessment
before embarking on a pregnancy,” said Dr Geetha.
How does the heart disease affect pregnancy?
A typical pregnancy causes an increase in blood
volume, up to 50 percent towards the late second
and early third trimesters. There is also an acute
increase in the blood volume during and following
delivery. The heart rate also increases towards term
and may precipitate abnormal heart rhythms in those
predisposed to it.
All of this can be dangerous for women with pre-
existing heart disease.
The higher risk of clotting in pregnancy also exposes
patients with mechanical heart valves to the risk of stroke
or clot formation in their valves.
GlobalHealthAndTravel.com