How can previous heart issues impact pregnancy?

Question

Hello doctor,

I am a 32-year-old woman, expecting my first child, and I am concerned about potential complications related to my heart condition during pregnancy. As someone with a pre-existing heart condition, I want to ensure the safest possible outcome for both myself and my baby. Can you provide insights into how heart conditions may affect pregnancy, the risk of birth defects, and any precautions or treatments I should consider to minimize complications during this crucial time? Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

A preconception assessment by both a high-risk obstetrician and a cardiologist is recommended. For women who have not had preconception counseling, a complete risk evaluation should occur at the first prenatal visit. Women with congenital heart disease should receive a preconception evaluation by a cardiologist with expertise in pregnancy and congenital heart disease. There is a Modified World Health Organization classification of maternal cardiovascular risk. You can easily check on WHO (word health organization) website.

The following maternal conditions pose very high maternal and/or fetal risk during pregnancy: significant pulmonary arterial hypertension of any cause, severe mitral stenosis, severe symptomatic aortic stenosis, bicuspid aortic valve with aorta diameter >50 mm, Marfan syndrome with aorta dilated >45 mm, severe systemic ventricular systolic dysfunction (left ventricular ejection fraction <30 percent, New York Heart Association III to IV), and native severe coarctation. Improved medical and surgical options have resulted in most women with congenital heart disease surviving to bear children. Despite these advances, congenital heart disease remains an important cause of maternal mortality and morbidity.

Impact of physiologic changes in pregnancy: Normal alterations in circulatory and respiratory physiology during pregnancy can have deleterious effects on the mother with congenital heart disease and on her developing fetus.
Hypercoagulability: This is a particular concern in women at risk for thrombosis related to prosthetic heart valves, atrial fibrillation, previous thromboembolic events, or intracardiac shunts. Such patients are candidates for anticoagulation. Considerations in choosing an anticoagulation regimen should include adverse fetal effects (eg, Warfarin embryopathy) in the first trimester, bleeding risk, and the risk of thrombosis on the prosthetic valve.

I hope this information will help you.

Thank you.