According to the European Society of Cardiology, heart disease is the leading cause of death during pregnancy. A number of women of childbearing age have congenital heart disease, while a new important group is represented by the so-called “old firstpares”, i.e. women who have their first child around the age of 40. In fact, as a woman grows older, the possibility of developing diseases such as different forms of ischaemic heart disease (angina pectoris and myocardial infarction) also increases.
Let’s see then 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 entails some changes in the cardiovascular system. This is particularly the case with:
- Increased oxygen demand
- increased range and heart rate
- increased 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.
CARDIOPATHY AND PREGNANCY: A MULTIDISCIPLINARY APPROACH
That’s why, like in 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 case of:
- Valve prostheses
- aortic coarctation
- Marfan syndrome (connective tissue)
- asymptomatic dilated myocardial disease
- obstructive lesions.
There are also more serious cases where heart disease is considered to be incompatible with pregnancy, so doctors believe that it should be avoided or terminated:
- pulmonary hypertension
- decompensated dilated cardiomyopathy
- Marfan syndrome with aortic dilatation
- congenital cyanogenic heart disease.
In cases of pregnant heart disease women, it is important to intervene with a multidisciplinary approach: cardiologists, gynaecologists and anaesthetists must work in teams and assist the patient at all stages. But what are the heart diseases with the greatest risks in pregnancy?
HEART DISEASE IN PREGNANCY: WHAT RISKS?
Not all diseases 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, reduced birth weight, 5-10% probability of congenital heart disease in the child.
- Aortic coarctation, responsible for about 3-8% of cases of maternal mortality
- Autosomal dominant disease – involving about 1-3% risk of sudden death
- Peripartum dilated myocardial disease, a rare disease that occurs during pregnancy (or immediately after) and may involve the risk of heart failure.
HEART TRANSPLANTATION AND PREGNANCY
Women who have undergone a heart transplant must also consider the risks. Although research on the subject shows that in most cases the pregnancy can be completed, 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 can carry out a pregnancy safely.
HEART DISEASE DURING PREGNANCY: WHICH DRUGS ARE ALLOWED?
In the case of heart disease during pregnancy, the cardiologist must take into consideration all the drugs usually prescribed to the patient and assess their compatibility with the pregnant state. In fact, vasodilators, antiarrhythmics and antithrombotic drugs can be effective in some cases, for example adenosine used in synchronized atrial arrhythmias, but involve serious risks for the woman and the fetus in other situations. This is the case, for example, with the antithrombotic Warfarin that crosses the placenta and can cause malformations of the fetus in 15-25% of cases.
As we know, ischaemic cardiovascular diseases mainly affect the female population, with a high incidence of heart attack, but this does not imply that women with heart disease should give up having children. In the presence of heart disease during pregnancy, it is necessary to know the risks, to rely on specialists and not to improvise, also evaluating with one’s own cardiologist whether to intervene with surgical correction, in order to significantly lower the risks. Finally, it may be useful to take out a Family Protection policy that covers the costs of many examinations, including echocardiography, which is essential for the diagnosis of many of the diseases we have mentioned.