As much as it is an exciting experience for most expectant parents, pregnancy can be challenging for women with pre-existing heart disease.
This is especially if it is unplanned — leading to possible complications for both the mother and her baby.
Based on the Malaysian Confidential Enquiry into Maternal Deaths (CEMD) data between 2009 and 2014, heart disease in pregnancy is the leading cause of indirect maternal deaths in Malaysia, contributing up to 50 per cent of these deaths.
It shows that one third of mothers who died had known heart disease prior to pregnancy.
For the uninitiated, pregnancy stresses the heart and circulatory system.
According to the National Heart Institute (IJN) senior consultant paediatric and adult congenital cardiologist Dr Geetha Kandavello, a typical pregnancy causes an increase in blood volume, up to 50 per cent towards the late second and early third trimesters.
“There is also an acute increase in the blood volume during and following delivery, which may be dangerous for women with pre-existing heart disease,” she said in a press release.
The heart rate also increases towards term and may precipitate abnormal heart rhythms in those predisposed to it.
Additionally, the higher risk of clotting in pregnancy exposes patients such as those with mechanical heart valves to the risk of stroke or clot formation in their valves.
Recognising the need for a more holistic solution, IJN in collaboration with the Maternal Fetal Medicine unit of Hospital Kuala Lumpur and IJN Foundation has embarked on a campaign called “Planned Pregnancy, Safer Outcome”, to help women with heart diseases have a safer pregnancy.
Dr Geetha said the institute offers comprehensive and holistic strategies to improve preconception counselling, antenatal and postpartum care for pregnant women with heart disease.
“Often, there is a delay in diagnosis or referral, but occasionally, the treatment is inadequate or suboptimal and this may be due to an unplanned pregnancy.
“Based on their cardiac obstetric combined clinic registry, more than 70 per cent of women with heart disease who became pregnant had no preconception counselling,” she added.
Dr Geetha stressed 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, symptoms and complications may start and develop as the pregnancy advances, increasing the risks to both mother and baby.
“Therefore women with or at risk of heart disease are advised to have preconception counselling.”
Based on current statistics, it is projected that the number of women in the childbearing age with heart disease is on the rise.
This further contributes to the prevalence of more complicated heart diseases due to the rising number of childhood survivors of congenital heart disease.
There is also the problem of advanced maternal age and co-morbidities such as hypertension, diabetes, high cholesterol and obesity predisposing women in the childbearing age to early onset coronary artery disease.
“Thus, it’s vital for women to have a cardiac assessment before embarking on a pregnancy,” she says.
Here are some preventive tips from Dr Geetha to help you have a safer pregnancy:
Undoubtedly a must for all women before marriage and attempting to become pregnant.
According to Dr Geetha, this should be introduced during puberty and re-emphasised again when they are young adults, prior to marriage and at least three to six months before pregnancy.
“It should involve the patient, partners and families,” she said.
She added that it was important to get a comprehensive medical assessment, review important past medical and obstetric issues, as well as medications as some medicines can be unsafe to the baby.
Contraception and heart disease
At the IJN-Maternity Hospital Kuala Lumpur (MHKL) cardiac obstetric combine clinic (IJN-MHKL COCC), Dr Geetha said, contraceptive advice is provided to women with heart disease who are in the childbearing age group to enable them to plan their pregnancies.
“Oral contraception and barrier methods (condoms) may not be the best of options for all patients.
“In fact, the standard oral contraceptive pills may not be suitable in many women with heart diseases,” she said.
Dr Geetha also advised that ideally, these women should be counselled and managed by a multidisciplinary team, consisting of cardiologist, maternal fetal medicine specialist (obstetricians), specialised nurses, obstetric and/or cardiac anesthetists and counsellors.