Pregnancy risk for heart patients
More doctors must be trained to prevent pregnant mothers with heart disease from dying unnecessarily, experts say.
Women with heart disease are 100 times more likely to die in pregnancy than other mothers-to-be, a report in the British Medical Journal says.
Complications can lead to a heart attack, stroke, and even the death of the mother, and there is a greater risk of harm to the baby.
Despite risks, pregnancy is feasible with the right support, the study says.
A group of medical experts will call at a conference in London this week for long-term investment in the training of professionals to raise awareness of and boost skills in dealing with the risks of congenital heart disease (CHD) in pregnancy.
Professor of Cardiology and Adult Congenital Heart Disease at the Royal Brompton Hospital Michael Gatzoulis says pregnancy is fraught with difficulties for the 125,000 women with congenital heart disease in the UK.
“Mothers with CHD are, on average, 100 times more likely to die during pregnancy than other pregnant women… especially if there are complications.
“If untreated, these can lead to a heart attack, stroke, flooding of the lungs and in some cases, sadly death.”
Heart disease is one of the biggest causes of maternal death, he added.
There are also risks for the baby including growth restriction, premature birth and miscarriage, as well as an increased chance of cardiac defects.
However, the report’s authors say that with the right advice from a specialist centre and careful planning of the baby’s delivery, most women with CHD can successfully have children.
They say: “Prolonged and difficult labour should be avoided, and detailed continuous monitoring of the mother and foetus is mandatory.
“The principle is to manage the stress of labour in such a way that it does not exceed the woman’s capacity to cope with it.”
Professor Gatzoulis said with 1% of children born worldwide with CHD, the challenge of raising awareness among patients was a big one.
‘Know the risks’
He pointed out that 85 to 90% of patients who had heart defects corrected as a baby, had no contact with the hospital where they had the operation.
“There should be a database of previous patients so you can track them down and make proper assessments. This is a life-long disease.
“Most women embark on pregnancy without knowing the risks and if they don’t have the right support the outcome is not always desirable.”
Philip Steer, Professor of Obstetrics and Gynaecology at Chelsea and Westminster Healthcare NHS Trust, said would-be mothers with CHD should receive advice and counselling about the risks before they become pregnant.
“When pregnant its essential they have specialist care, especially antenatally and in labour, and they need good after care too.
“If they don’t get the care they deserve, sadly some women will continue to die needlessly.”
Judy O’Sullivan, Cardiac Nurse at the British Heart Foundation, said the better the care that women with CHD receive, the better the chances of good health for both mother and baby.
“We would encourage all women with CHD, especially those with complicated heart problems, who are pregnant or planning a pregnancy to seek expert medical advice to manage their own heart health and the health of their baby.”
Professor Sidney Smith, Chairman of the World Heart Federation Scientific Advisory Board, said his organisation supported twin centers grants where specialist training is available and sponsors public education programs on heart disease and women.
“Many unneccessary deaths of women during pregancy can be prevented by such efforts in appropriate training and education”.
Revision date: July 5, 2011
Last revised: by Andrew G. Epstein, M.D.