Motherhood Story features a heart-to-heart talk with Dr. Tee Chee Hian, a Consultant Cardiologist & Internal Medicine at Sunway Medical Centre Velocity, about cardiovascular complications during pregnancy.
For pregnant mummies who have heart conditions, do take heed of some expert advise as shared by Dr. Tee. Understanding some risk factors, safe delivery methods, to managing the condition with the help of a cardiologist, Dr. Tee gives us an overall view of what to expect.
Is pregnancy a risk factor for heart disease in healthy women with no prior history of cardiac disease?
Pregnancy itself is not a risk factor for heart disease in normal, healthy women. In fact, pregnancy is a normal physiological change, and won’t affect a normal healthy woman’s general condition.
At which stage is a woman with cardio disease most vulnerable during the pregnancy term?
1) During the third trimester.
As pregnancy progresses, enlarged gravid uterus will cause splinting of diaphragm and reduce oxygen reserve, thus causing hypoxemia. Therefore, it will increase the work of breathing. It will also increase cardiac output and myocardial oxygen consumption.
2) Immediately after delivery.
It will increase venous return (blood back to maternal’s circulation) and the risk of pulmonary edema (acute lung congestion) or acute heart failure.
What causes heart problems during pregnancy?
During pregnancy, changes occur to the heart and blood vessels and these changes can put extra stress on a woman’s body and require the heart to work harder. These changes will increase cardiac output, which refers to the amount of blood pumped by the heart each minute, during pregnancy. There will also be an increase in the maternal heart rate and increase in blood volume.
What are the initial signs or symptoms to look out for to detect heart problems?
For those who have pre-existing heart related disease, particularly prior history of cardiac event, there is a need to have close follow up with a cardiologist during pregnancy. For those without prior heart-related disease, many of the normal symptom of pregnancy, for example, dyspnea on exertion, ankle swelling, palpitation and orthopnea are also symptoms of heart failure.
However, conditions such as angina, resting dyspnea, paroxysmal nocturnal dyspnea or sustained arrhythmia (prolonged duration of irregular heart beat) during pregnancy would warrant further cardiac work-out by a cardiologist.
What are the most common risks or complications of heart disease during pregnancy?
Pregnant women with pre-existing cardiac disease/pathology will have a higher chance of developing heart failure or arrhythmia due to pregnancy induced stress. Furthermore, during pregnancy, a mother’s heart will need to supply blood and nutrient to the foetus, so the mother’s cardiac output will increase. This leads to a possibility of developing heart failure.
Once a mother’s condition is not stable or unable to provide enough blood supply and nutrient to the foetus, this will lead to growth retardation of the foetus. In severe cases, preterm labour, foetal and mother death may occur.
How can pregnant women with heart disease manage their health during pregnancy and avoid a heart attack?
For pregnant patients with pre-existing heart disease, it is important to be compliant with medications prescribed to them. Strict follow up with cardiologist and O&G specialist is needed.
They also need to control their fluid and salt intake. Those with arrhythmia problem need to take their medication regularly. Self-monitoring of worsening of short of breath, chest pain, etc. is needed. If symptoms worsen, do seek early treatment.
Which type of delivery is safest for a woman with cardiac complications?
Normally, for those with stable heart disease during pregnancy, spontaneous vaginal delivery is allowed, provided adequate pain relief is administered and a shorter second stage of delivery.
For moderate to severe cardiac disease such as aortic stenosis (with fixed cardiac output), planned caesarean section will be considered a safer option. Meanwhile, for those who plan for elective caesarean section, multi-disciplinary meeting among obstetrician, paediatrician, anaesthetist and cardiologist is needed before the procedure.
For planned caesarean section, close monitoring is needed during anaesthesia. The anaesthetist will decide the most suitable mode of anaesthesia to ensure safety of the delivery.
How does a heart condition affect the pregnancy and baby?
- Maternal complications: Heart failure, arrhythmia, maternal death
- Foetal complications: intrauterine growth restriction, pre-term labour, foetal death
When a woman with a heart condition gives birth, what should they expect with their heart health postpartum?
They need to watch out for heart failure as postpartum cardiomyopathy is a serious and life threatening condition. Normally, those with heart condition who are doing well postpartum will be closely monitored post-delivery.
How can we keep our heart healthy during pregnancy?
- A balanced diet is important for both mother and foetus.
- Moderate exercise is needed even during pregnancy according to guidelines.
- Get enough sleep to ensure foetus is growing in a healthy environment.
- For those who has a habit of drinking alcohol and smoking, it is advised to stop completely.
- Avoid stress, as this is one risk factor that is not good for heart health.