In a recent paper, researchers find pregnant women with heart disease should give birth at no later than 40 weeks gestation.
Heart disease is the main reason women die during pregnancy in western countries.
Research has found that compared to healthy pregnant women, those with heart disease have a much greater risk of death or heart failure.
Most women with heart disease can have a healthy pregnancy, but they should be aware that they have a higher risk of complications including premature labour, pre-eclampsia, and post-partum bleeding.
In addition, it is estimated that 18-30% of children have complications and up to 4% of neonates die.
Many factors can contribute to heart disease, including hypertension, diabetes and overweight.
These factors are also on the rise in pregnancy as older women become pregnant and women now acquire risk factors at a younger age.
The researchers suggest that beyond 40 weeks, pregnancy has no added benefit for the baby and may even have negative effects
In the paper, the guidelines provide recommendations on in vitro fertilisation (IVF), contraception, and termination of pregnancy in women with heart disease.
IVF often uses high doses of hormones, which increase the risk of thrombosis and heart failure, so women with heart disease need a cardiologist’s confirmation that the chosen method is safe.
Since carrying more than one baby puts more stress on the heart, women with heart disease undergoing IVF are strongly advised to transfer a single embryo.
Girls with congenital heart disease need contraception advice to avoid unplanned pregnancy. Some contraception methods are contraindicated in patients with certain types of heart disease.
In addition, pregnancy is not recommended in patients with certain types of heart disease—for example, pulmonary arterial hypertension, severely dilated aorta, or severely reduced ability of the heart to pump blood.
The guidelines also suggest women with heart disease who want to have a baby need pre-pregnancy risk assessment and counselling.
Those at moderate to high risk of complications should be reviewed by a pregnancy heart team with a cardiologist, obstetrician, gynaecologist, and anaesthesiologist.
A delivery plan should be devised at 20-30 weeks specifying vaginal or caesarean delivery, whether an epidural or forceps will be used, and the duration of hospital stay after delivery.
The guidelines are published in European Heart Journal.
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Source: European Heart Journal.