- Heart disease in pregnancy: what you need to know
- Heart disease and pregnancy: a multidisciplinary approach
- Heart disease in pregnancy: what are the risks?
- Heart transplant and pregnancy
- Heart disease in pregnancy: which drugs are allowed?
Heart disease is the leading cause of death in pregnancy, according to the European Society of Cardiology. A part of women of childbearing age have congenital heart diseases, while a new important group is represented by the so-called ” elderly primiparas “, that is, women who have their first child around 40 years of age. In fact, as the woman ages, the possibility of developing diseases such as the various forms of ischemic heart disease (angina pectoris and myocardial infarction) also increases. So let’s see what are the main risks of heart disease in pregnancy.
HEART DISEASE IN PREGNANCY: WHAT YOU NEED TO KNOW
First of all, it is important to say that pregnancy in itself involves some changes in the cardiovascular system. In particular, these are:
- increased oxygen demand
- increased range and heart rate
- increase in blood volume
- reduction in blood pressure.
Therefore, heart patients must be followed with particular attention and must be aware that their interesting state will tend to make the situation more delicate.
HEART DISEASE AND PREGNANCY: A MULTIDISCIPLINARY APPROACH
This is why, similar to vascular prevention, women with known heart disease should undergo pre-pregnancy counseling to assess maternal and fetal risk. In particular, this analysis is required in the case of:
- valve prostheses
- aortic coarctation
- Marfan syndrome (connective tissue)
- asymptomatic dilative cardiomyopathy
- obstructive lesions.
There are also more serious cases in which it is believed that heart disease is incompatible with pregnancy, for which doctors believe it should be avoided or interrupted:
- pulmonary hypertension
- decompensated dilated cardiomyopathy
- Marfan syndrome with aortic dilation
- cyanogenic congenital heart disease.
In cases of pregnant women with heart disease, it is important to intervene with a multidisciplinary approach: cardiologists, gynecologists, and anesthetists must work as a team and assist the patient in all phases. But which are the heart diseases with the greatest risks in pregnancy?
HEART DISEASE IN PREGNANCY: WHAT ARE THE RISKS?
Not all pathologies affecting the cardiovascular system are of the same severity. In particular, among the high-risk heart diseases in pregnancy we find:
- Tetralogy of Fallot, for which the risks are high maternal mortality, fetal loss, premature birth, low birth weight, 5-10% probability of congenital heart disease in the child
- Aortic coarctation, responsible for approximately 3-8% of maternal mortality cases
- Autosomal dominant disease – which carries about a 1-3% risk of sudden death
- Peripartum dilated cardiomyopathy, a rare disease that occurs during pregnancy (or soon after) and can carry a risk of heart failure.
HEART TRANSPLANT AND PREGNANCY
Women who have undergone a heart transplant also need to consider the risks. Although the research carried out on the subject shows that in most cases the pregnancy can be carried to term, there are still risks, represented by maternal heart failure and maternal infections. For this reason, it is believed that only women who have undergone transplantation at a young age and without rejection phenomena can carry out a pregnancy safely.
HEART DISEASE IN PREGNANCY: WHICH DRUGS ARE ALLOWED?
In case of heart disease during pregnancy, the cardiologist must take into consideration all the drugs usually prescribed to the patient and evaluate their compatibility with the pregnancy. Indeed, vasodilators, antiarrhythmics, and antithrombotics may be effective in some cases, for example, adenosine used in synchronized atrial arrhythmias, but carry serious risks for the woman and the fetus in other situations. This is the case, for example, of the antithrombotic Warfarin which crosses the placenta and can cause malformations of the fetus in 15-25% of cases.
As we know, ischemic cardiovascular diseases mainly affect the female population, with a high incidence of heart attacks, but this does not imply that women with heart disease should give up having children. In the presence of heart disease in pregnancy, it is necessary to know the risks, rely on specialists, and not improvise, even evaluating with your cardiologist whether to intervene with surgical correction, to significantly lower the risks. Finally, it may be useful to take out a medicare insurance policy such as Family Protection that covers the costs of many tests, including echocardiography, which is essential for the diagnosis of many of the diseases we have talked about.