Congenital heart diseases are malformations of the heart that occurred in the womb and babies are born with them. In developed countries with advanced form of management, many patients with congenital heart diseases live to adulthood. This has resulted in a steady increase in the number of females with congenital heart diseases reaching childbearing age. In fact, congenital heart diseases are now the predominant form of heart diseases encountered during pregnancy in developed countries. The story is getting better in Nigeria with many patients being referred from pediatric cardiology to adult cardiology for further management. The women among them will eventually marry and the society expects them to get pregnant as soon as God allows.

In tertiary institutions in the country, there are more referrals of such patients from the obstetricians to the cardiologists and vice versa.  Pregnancy in a woman with congenital heart disease affects the mother and her fetus. The obstetrician (specialist in pregnancy) and cardiologist (specialist in heart diseases) are therefore responsible for the welfare of this two in one patient. Without causing fear in our heart, women with heart diseases need to plan their pregnancies based on the functional ability of the heart. Tolerability of pregnancy depends solely on the severity of the heart disease. During the preconception assessment, the risk to both the mother and the fetus are assessed, helping in proper counseling whether to be pregnant or not.

Most women do not find this preconception assessment necessary especially when the congenital heart disease is not giving them any symptom yet. To worsen it, some women hide information about their heart disease away from their husbands with fear that if the man knows on time, he may call it quit with them. This attitude should change.

Recently a woman with hole in the heart from childhood got married in Lagos without disclosing the details of the heart disease to the man. She went through two pregnancies without much problem but now she has developed heart failure. The man needs more children and the heart cannot cope again, and pressure is so much on her which further worsens the heart failing conditions. The man is yet to have the full picture of the condition and this woman now needs close to 2 million naira for open heart surgery outside the country. Who bears the responsibility? Is it the innocent husband?

If the man had known about the case, the family would have been well planned by them in conjunction with a cardiologist and obstetrician.  I advocate preconception assessment for all our women at child bearing age in other to reduce heart related maternal and fetal deaths

The main congenital heart diseases that are commonly encountered are hole in the heart, patent ductusarteriousus (communication between aorta and pulmonary trunk leading to mixing of oxygen rich blood with oxygen poor blood), obstruction of aorta( major conduit vessel that carry oxygen rich blood from heart to the body), and tetralogy of fallot( mixture of malformation involving the vessels and the heart chambers).

Maternal outcome
Hole in the heart, that is ventricular septal  defect (VSD) and atrial septal defect(ASD) have a better outcome compared with other congenital heart diseases especially the ones that cause cyanosis( Bluish discoloration of tongue and body). Likely deleterious outcome in improperly managed cases are heart failure, arrhythmias (abnormal rhythm of the heart that lead to death if not treated on time), infective endocarditis (infection of the interior part of the heart), and sudden death.

The risk is almost as those without heart diseases if the hole in the heart is closed before complications

Fetal outcome
Pregnant women with congenital heart diseases have an increased risk of neonatal complications including fetal wastages, low birth weight, prematurity, respiratory problems and congenital malformations.

Generally, the risk of congenital heart diseases in offspring of mothers with congenital heart diseases is reported to be 4 to 8%. In cases of hole in the heart, the incidence of septal defect in offspring has been reported to be 4 to 11%.

The congenital deformation in fetus in the womb can be minimized if you register in a good hospital on time. Don’t hide your heart diseases from your spouse. Manage your home together.

Once again, I wish you a noiseless pregnancy period. 

Till next week, maintain a healthy heart.