Doctors have long advised women born with complex congenital heart defects not to get pregnant due to the detrimental effect pregnancy and delivery would have on their bodies. But now, more and more health professionals are starting to open their minds to new possibilities.
A 2005 study discussed the risks associated with pregnancy in women with congenital heart disease, the most common birth defect. Congenital heart disease severity varies, from small atrial or ventricular septal defects to more severe cases of complex abnormalities that require surgical intervention.
Risks associated with pregnancy in women with congenital heart disease include adverse outcomes for both the mother and the baby stemming from significant hemodynamic changes: increased cardiac output, heart rate, blood volume, and venous return during delivery. A woman with congenital heart disease does not tolerate these changes as well as a woman with no defect.
In addition to the risks surrounding changes in maternal blood flow, for mothers with congenital heart disease, there is an increased risk of of their children also having a congenital heart defect: nearly 50 percent, instead of just a three percent risk present in healthy women.
But oday there is a new set of recommendations for health care providers published by the American Heart Association concerning women with heart defects wishing to have children. "There is a burgeoning group of women born with complex congenital heart disease who are now of childbearing age and want to get pregnant," said Mary Canobbio, chair of the group that wrote the scientific statement. "The problem is, pregnancy in this population is very risky."
Canobbio led the charge looking for information on these types of high-risk pregnancies. "We really didn't have any data to refer to in order to help [women]make safe, informed decisions," she said. She analyzed data from all over the country, associating cases of successful pregnancies in women with congenital heart disease with specific preventative measures taken and other factors.
"We found that if women's heart health is stable at the onset, we can get them through pregnancy," Canobbio said. "But that doesn't mean that they're not at risk for complications. We need to have a lot of people in place in order to ensure that we manage their care at an optimum level, at every stage."
For a woman with congenital heart disease, Canobbio’s research does not suddenly erase the danger of a potential pregnancy. However, her data analysis does provide resources for women trying to decide whether or not to take a risk. "We want each woman to understand the risks before she ever considers pregnancy, and understand the effect it might have on her heart in the long run,” Canobbio explained.
The recommendations included in the new AHA statement include guidance before, during, and after pregnancy. For example, AHA experts recommend that women with congenital heart defects try counseling with cardiologists, an OB-GYN, and even genetic counselors. Also, women are advised to receive electrocardiograms, echocardiograms, and exercise stress tests to get a clear picture of the current state of their heart’s health, just one part of the close monitoring that would continue throughout their pregnancy.
"We need to make sure the heart is strong enough to sustain both mother and baby,” explained Dr. Brian Koos, an OB-GYN with a specialization in high-risk pregnancies and also a co-author of the recommendations.
Canobbio believes that these new AHA recommendations offer new opportunities for women who might never have planned on having children. "Instead of having to tell them they can never become pregnant, with these recommendations in place, we can now give them data-based information and, possibly, new hope for having babies.”
The new AHA recommendations were recently published in the journal Circulation.