Due to advances in the treatment of children with congenital heart defects (CHD), more women with CHD are reaching adulthood and opting to have children. Often considered too risky, pregnancy among these women is becoming increasingly common thanks to advances in medicine and specialized care.
The Heart Disease and Pregnancy Program at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital takes a multidisciplinary approach to care for women with heart defects and heart disease by bringing together specialists from maternal fetal medicine, reproductive genetics, anesthesia and cardiology to offer preconception counseling and care for expectant mothers with CHD. Created by Northwestern Memorial Cardiologist Marla Mendelson, MD some 20 years ago, the Heart Disease and Pregnancy program has followed more than 2,000 women with various types of heart disease and congenital defects through their pregnancies since the program’s inception.
“Our goal is a successful outcome for both mother and baby,” says Mendelson, who also is director of the Bluhm Cardiovascular Institute’s Center for Women’s Cardiovascular Health. “That’s why it is imperative that all women with CHD or some form of heart disease who are of childbearing age and are contemplating pregnancy receive a complete preconception evaluation prior to becoming pregnant. Intervention before pregnancy significantly improves the chances of having an uncomplicated pregnancy and a safe delivery.”
During pregnancy, changes occur in the mother’s circulatory system, most of which are expected and normal. But in a woman with heart disease, these changes must be monitored carefully as they may become problematic. Pregnancy requires a mother’s circulatory system to provide additional blood to the uterus and placenta, and therefore causes an increase in blood volume. As blood volume rises, plasma in the blood increases faster than blood cells, which could result in an anemia during pregnancy that may increase demands on the heart. This change peaks during the 24th through 26th weeks of pregnancy, a time when the plasma volume can increase by as much as 50 percent more than levels during a non-pregnant state.
In most cases, women with CHD have had surgery as children, enabling them to develop normally. However, surgery does not eliminate the problem and additional cardiac troubles may arise in adulthood, especially if a woman has been given a pacemaker or is on medication.
According to a study reported last year in “Circulation,” the official journal of the American Heart Association, of which Mendelson is a member, an estimated one in every 250 adults had CHD in 2000 and the number continues to rise. Other heart conditions treated through the Heart Disease and Pregnancy program include mitral regurgitation, aortic regurgitation, hypertrophic cardiomyopathy, mitral valve prolapse and intracardiac shunts such as atrial septal defects and ventricular septal defects. For more information about the program, please visit www.nmh.org.
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