Do you know that pregnancy isn’t recommended for all women? Do you know that women born with some heart conditions or heart damage, if they get pregnant, may do so at their peril?
No doubt, it is easy to forget how risky pregnancy and childbirth are in general. But for women with heart disease, there are increased risks to both the mother and her unborn baby. In certain cases that risk is significant enough that pregnancy is not recommended.
According to the Center for Disease Control and Prevention, among women who die during pregnancy or within a year afterwards, heart-related problems account for more than four in 10 deaths.
For women born with some heart defects, having a baby can be risky. It can be even more of a threat because pregnancy stresses the heart and circulatory system.
“Pregnancy carries some risk for women even without heart disease; however, there are increased risks to both the mother and the foetus in the woman with congenital heart disease. Such women may have adverse outcomes that could lead to disability or death,” said Dr Tosin Majekodunmi, a Consultant Cardiologist.
Majekodunmi, the Medical Director and Chief of Cardiology, Euracare Multi-Specialist Hospital, Lagos, stated that women with weak hearts often have complications in pregnancy and may even be advised not to get pregnant.
He declared, “in countries like the UK, they had found that the biggest reason why a woman in pregnancy may have an adverse outcome is not related to obstetric problem but related to heart problems.
“A large proportion of ladies who are pregnant, who have a heart condition that has not been recognised had adverse events in pregnancy; these included things like essential hypertension, weak heart or heart valves that are not allowing blood to leave the heart easily.
“For instance, a lady that we treated at Euracare Multi-Specialist Hospital, Lagos, had a heart valve that severely narrowed blood leaving her heart. It has allowed her to remain alive but if she tries to get pregnant or deliver with a heart like that, the likelihood of an adverse outcome was very high.”
Dr Majekodunmi declared that in pregnancy, the heart has to work twice as hard as it normally does, up till about the third trimester.
He added, If a pregnant woman has a heart that is just working on the edge of what it can cope with when not pregnant; when she is in labour and the heart output exceeds what the heart can cope with, the heart is bound to fail. She may suffer a heart failure; she can pass away because the heart suddenly gives up.
“If it has not been diagonised before, it will just happen at labour and the midwife will come out and say sorry we are not sure what happened, she did not make it.”
The cardiologist stated that the consequences of a heart condition in pregnant women may range from early miscarriage, preterm labour, heart failure, stroke, to breathing problems and abnormal heart rhythm issues (arrhythmia).
Miscarriages occur more often in some of these women. More than a quarter of newborns have complications, such as being underweight, not growing well in the womb and respiratory distress at birth.
He stated, “such women are not advised to get pregnant until the problem(s) associated with their heart is assessed and something is done to fix it and reduce the risk.
“The most feared consequences obviously by anyone is dying either during the pregnancy or shortly thereafter and that is why we usually counsel these ladies to absolutely not get pregnant until their heart is fixed or can be fixed.”
Pregnancy requires the heart to work harder. Consequently, pregnancy may worsen a heart disorder or cause a heart disorder to produce symptoms for the first time.
Professor Adewale Sule Odu, a consultant, Obstetric and Gynaecologist, Olabisi Onabanjo University Teaching Hospital, stated that pregnancy in women with heart problems is usually difficult.
According to Sule Odu, “If care is not taken, she may even die before delivery. The greatest problem the woman may have is during labour itself. In fact, such patients are not allowed to go into labour.
“I had a patient like that once. We managed to deliver her babies prematurely twice because she could not carry that pregnancy to term. But after the second delivery, she did not last for more than one year before she died. The pregnancy contributed to an early demise.”
After delivery, women with a severe heart disorder may not be out of danger for six months, depending on the type of heart disorder.
Professor Sule Odu added that women with kidney problems and sickle cell disease could also have challenges with pregnancy.
“Such women need to see the doctor before getting pregnant. They have to be assessed properly. It is not that they cannot deliver, but it is going to be a difficult situation also. Some of these women may require having their babies through caesarian operation based on the kind of medical condition they have, too.”
These high-risk pregnancies, he stated, required specialist care, adding that unlike other pregnant women, their clinic appointments are shorter to monitor the baby’s development throughout the pregnancy.
He, however, stressed the importance of every woman capable of becoming pregnant seeking preconception care, regardless of whether she is planning to conceive.
Preconception care is aimed at identifying and modifying biomedical, behavioural, and social risks through preventive and management interventions. Key components include risk assessment, health promotion, and medical and psychosocial interventions.
Meanwhile, President, American College of Obstetricians and Gynecologists (ACOG) Dr Lisa Hollier, in an organisation news release stated that, “Most of these deaths are preventable, but we are missing opportunities to identify risk factors prior to pregnancy and there are often delays in recognising symptoms during pregnancy and postpartum, particularly for black women.”
The American Heart Association recommends taking the following precautions before getting pregnant: Watch your diet and limit your sodium intake, start (and maintain) 150 minutes of physical activity per week, stop using tobacco and alcohol and lose weight.