Pregnancy in Women With Congenital Heart Disease

Naveen L. Pereira, MD; Carole A. Warnes, MD


February 03, 2014

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In This Article

Preconception Counseling

Dr. Pereira: You pointed out that most women can tolerate pregnancy, and in a tertiary care referral center with cardiologists who are experienced in taking care of these patients, pregnancy can have a successful outcome. When you counsel the patient, what advice do you give them from before conception through the time of delivery?

Dr. Warnes: The prepregnancy evaluation is key. For congenital heart disease, it falls into 2 broad issues: What is the risk to the mother, and what is the risk to the baby? You need a detailed evaluation of the mother, a clinical examination, with echocardiography and an exercise test. Patients with congenital heart disease have never known "normal" exercise, so you want to determine the functional capacity of the mother.

You need to discuss the risk that pregnancy will impose, how the pregnant woman should be managed, where she should be managed, and where she should deliver. You need to review what drugs the woman might already be taking. Should she continue taking these drugs, or do these drugs pose a risk to the fetus?

From the fetal perspective, what is the risk for the child having congenital heart disease? Will the fetus be safe? Should we obtain a fetal cardiac echocardiogram to assess for congenital heart disease at 20-24 weeks' gestation? Does the mother have a genetic condition that might significantly increase the baby's risk of having congenital heart disease?

There needs to be a discussion about the mother's prognosis in general. Women are often very driven to have at least one pregnancy. The concern, however, is not just getting through the pregnancy, but how the volume load of pregnancy might permanently distort her cardiovascular hemodynamics, perhaps making an atrioventricular valve more regurgitant. The mother might not return to baseline even after a successful delivery. We need to consider the potential negative impact on the mother's baseline hemodynamics.

Finally, it is important to discuss maternal prognosis. What is her life expectancy? Will women with complex heart disease, such as single-ventricle transposition of the great arteries, live long enough to see their children go off to college? That is a difficult and sensitive discussion, but it needs to take place.


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