Rubaiya, my friend came to me few days ago in an evening. She was a bit anxious. She said, “Doctor, I am expecting but I have a hole in my heart. Now I am having respiratory distress while working or climbing stairs and chest pain as well.”
A woman who has a hole in the heart detected earlier as atrial septal defect (ASD) should be closed in time. Sometimes this type of defect in heart remain undetected as the child having ASD seldom has symptoms. Moderate to large atrial septal defect which may cause palpitation, chest pain and/or tiredness during playing or heavy work or sometimes poor weight gain during childhood.
Due to less symptoms of ASD, children are often ignored and develop severe pulmonary arterial hypertension (PAH) with respiratory distress at later age, even during routine checkup of pregnancy. Because the physiological and haemodynamic adaptation during pregnancy are poorly tolerated in pulmonary hypertension patients.
If mother has large ASD with severe pulmonary arterial hypertension, it becomes life threatening for both the mother and child. Even in accordance to European guidelines, PAH considered as a contraindication to pregnancy with an associated 30-50% risk of mortality. The woman who choose to proceed with high risk pregnancy with PAH should be treated with disease targeted therapies and have facilities of planned elective caesarian section with close collaboration of multi-disciplinary team.
Any valvular heart defect detected in childhood of a woman should also be evaluated by a cardiologist before planning the pregnancy. Because team work of obstetrician, cardiologist, neonatologist and paediatric cardiologist during planned delivery in hospital will make the things easy and systematic.
Hypertension should be under control during pregnancy. If a woman has hypertension and is taking some antihypertensive medication, she must consult with her cardiologist and gynaecologist before planning for pregnancy. Because, taking these medications during pregnancy have been reported to cause congenital malformations of heart as atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA) and pulmonary stenosis (PS).
Mothers having congenital heart diseases (CHD) even if it is post-operative have 15% incidence of CHD of their child. So, after birth, echocardiography of children is beneficial. Even foetal echocardiography during pregnancy can be done.
Maternal ingestion of high dose aspirin also causes harm to the foetuses which may results in persistent pulmonary hypertension of newborn (PPHN).
Increased heart rate (tachyarrhythmia) are the most frequently observed cardiac complications during pregnancy. The use of the antiarrhythmic drugs (AADs) during pregnancy is challenging due to potential foetal teratogenic effect. Hence initiation of antiarrhythmic drug therapy by physician requires careful consideration of the potential risks and benefits to the individual patients.
For the safety of the mother and baby, judicious management is essential undoubtedly. Awareness regarding heart diseases of mother and proper management would make our future baby safe.
The writer is a Consultant Paediatric Cardiologist at Apollo Hospitals, Dhaka.