
When most women think about heart disease during pregnancy, they may think about high blood pressure, or other conditions that develop during pregnancy. But for women with congenital heart disease,
(cardiac disease that is present from birth throughout their lives), pregnancy itself can present potential serious side effects and
cardiac complications.
Adult congenital heart disease (ACHD) describes a number of different problems affecting the heart. It is the most common type of birth defect, and while some problems can be
corrected, they may still require medical supervision throughout a person’s life
especially during pregnancy.
“It’s estimated there are more than one million adults with congenital heart
disease in the United States,” says Yuli Kim, director of the Philadelphia
Adult Congenital Heart Center. “More and more children with congenital
heart disease are reaching reproductive age, and need high-risk obstetrical
care in collaboration with specialized cardiac care.”
Women with congenital heart disease are seen at the Pennsylvania Cardiology Associates or at
The Philadelphia Adult Congenital Heart Center, a joint effort between Penn Medicine and the
Children’s Hospital of Philadelphia (CHOP). Together, they serve the unique health care needs
of these patients. The center is comprised of specialists in cardiology, cardiovascular surgery,
non-invasive imaging, genetics and reproductive services that care for patients with congenital
heart disease. The center also offers high-risk obstetrical care through Penn’s Maternal Fetal
Medicine specialists. High-Risk Care
“Pre-conception care is recommended for any woman who plans to get
pregnant,” says Sindhu Srinivas, MD, MSCE, director of obstetrical services
at the Hospital of the University of Pennsylvania. Getting to a healthy weight prior to
conception and eliminating dangerous exposures such as smoking are emphasized
to all women. “But a woman with cardiac disease needs counseling beyond
what a woman without cardiac disease may need.”
At Penn, women with a history of congenital heart disease receive pre-conception
counseling from a multi-disciplinary team of cardiologists and maternal fetal medicine
specialists and geneticists.A maternal fetal medicine specialist is an obstetrician who
has received additional training in the evaluation and care of high-risk pregnancies.
A geneticist can help you determine if you are at an increased risk for having
a child with a congenital heart defect. The specialist may recommend a fetal
echocardiogram during pregnancy to evaluate the fetal heart. In some cases a
specific genetic test may be recommended to determine whether the mother and/or
fetus has a genetic cause of congenital heart disease.
“It’s important we work together to create a plan and make recommendations
to women with cardiac disease,” says Dr. Kim. “Together, we can talk about
possible risks, and how to manage cardiac disease during pregnancy.”
Ensuring a Healthy Pregnancy and Delivery
“In some forms of structural heart disease, there is a risk of peripartum
heart failure or other complications that may be caused due to the physiologic
changes of pregnancy,” says Robert Debbs, MD, Director of the
Maternal Fetal
Medicine Network in New Jersey.
With careful planning and prenatal care, the risks of adverse
outcomes appear to be very small. In fact, most women with a repaired congenital
heart defect can enjoy full-term deliveries and rarely need a cesarean section
due to their heart disease.
“Because there are so many variables involved with both
a woman’s cardiac condition, pregnancy and delivery,” adds
Dr. Srinivas, “it’s important for women to get their pre-conception
and prenatal care from a multi-disciplinary team of experts experienced in
managing high-risk pregnancies and cardiac conditions.”