According to health experts, pregnancy itself leads to certain changes in the cardiovascular system in order to improve the blood supply to the growing foetus. However, in this scenario, it can unmask certain unknown pre-existing cardiac problems or can aggravate them and along with that, excessive weight gain, anemia, gestational diabetes mellitus and hypertension in pregnancy can complicate the pregnancy even further in a pregnant woman with heart disease.
In an interview with HT Lifestyle, Dr Sujit Ash, Consultant, Gynaecology and Obstetrics, shared, “It becomes imperative to evaluate a woman at the pre-pregnancy phase so as to avoid exacerbations and complications in the pregnancy, as this can not only be deleterious for the growing fetus but is often life-threatening for the pregnant mother. It is important that the mother highlights any history of cardiac disease like cardiomyopathy or myocardial infarction or congenital heart disease. Detailed history regarding substance abuse like cocaine or amphetamines, smoking, lifestyle diseases like obesity, hypertension, and family history is necessary too.”
With the physiological changes beginning as early as 5-6 weeks of pregnancy, Dr Sujit Ash advised early detection and management of heart conditions will improve the outcomes in pregnancy. He said, “There are changes in the heart rate, the contractility of the muscles of the heart, the blood pressure and hemoglobin levels. So, its wiser to ask for symptoms like chest pain, tiredness, shortness of breath while exertion or while sleeping, black out spells. Also examining the patient for high heart rate or high blood pressure, abnormal heart sounds, changes due to cardiac failure is vital. Investigations like ECG, 2D Echo provide a better picture in picking up these insults and to give adequate treatment that can be individualised. Certain drugs for heart disease are contraindicated in pregnancy, so it has to be changed. Medicines can be targeted on reducing the workload on the heart (cardio-selective beta blockers or calcium channel blockers) or to avoid any clotting disorders (aspirin or low molecular weight heparin).”
He added, “It is essential to keep the hemoglobin, fluid intake and signs and symptoms in check. The mother has to be evaluated in every visit that will be more frequent for her as compared to any other pregnant woman. Fetal monitoring with check on fetal well-being, interval growth and blood flow to the fetus is to be done in every visit too. Labor itself can add to more stress on the heart so it has to be monitored extensively, with provisions of trained staff, labor analgesia, fluid monitoring, electronic fetal monitoring, instrumental delivery, ICU back-up at the place of delivery. Heart disease in pregnancy is a complicated high-risk status for a mother, and it is necessary to have a multi-disciplinary team of doctors including obstetrician, cardiologist, intensivist, anesthetist, and neonatologist on board, to reduce the morbidity and mortality associated, and to provide better maternal and perinatal outcomes.”
Talking about the importance of vigilantly monitoring a woman’s cardiovascular health during pregnancy, Dr Pranathi Reddy, Clinical Director at BirthRight By Rainbow Hospitals, said, “During pregnancy, a woman is inherently prone to a significant amount of strain on her cardiovascular system. She experiences hormonal changes & fluctuations and increased blood volume which leads to additional stress on the heart that may pose underlying conditions or even reveal previously undetected issues & risks. Conditions like gestational diabetes and high blood pressure can also surface which can in turn heighten the risk of heart complications. Therefore, it is important for expecting mothers to undergo thorough pre-conception screenings and maintain regular check-ups throughout their pregnancy.”
Highlighting the importance of personalised care, she said, “Every pregnancy is unique and so is its influence and effects on every woman’s heart. Custom tailored medical management strategy for every pregnant woman is thus imperative. This strategy involves specialized diets, modified exercise routines and in some cases, carefully monitored medication regimens. Patients and their families are advised to constantly & openly communicate with their gynecologist in charge and seek the help and guidance of other doctors as well, whenever it seems necessary according to the recommendations of the primary doctor. Close collaboration between obstetricians and cardiologists to ensure optimal maternal and fetal heart health is also imperative. Finally, education is empowering. Expectant mothers should be well-informed about recognizing warning signs and understanding when to seek immediate medical attention. With the right knowledge and proactive healthcare, it is possible to alleviate the risks associated with heart disease during pregnancy.”
Bringing her expertise to the same, Dr Vaishali Joshi, Consultant – Obstetrician and Gynaecologist at Kokilaben Dhirubhai Ambani Hospital in Mumbai, revealed, “Pregnancy initiates myriad of changes in the body. There is increase in the heart rate by 10 %, the blood volume increases by 30-40 % and heart has to function more effectively and strongly to meet up the demands of the mother and developing baby. In current era, the average age of the expecting mothers has increased to late thirties and early forties. The age related risks of co-morbidities or pre- existing illnesses like diabetes, gestational diabetes, High blood pressure, hyper lipedema, obesity, smoking, multiple pregnancies have direct effect on the heart ailments. They give rise to compromised function of cardiac system which can get decompensated due to natural changes of pregnancy and women becomes symptomatic.”
Asserting that detection of heart disease in pregnancy can be challenging as many normal complaints related to pregnancy and heart diseases symptoms are similar, e.g breathlessness, fast heart rate or palpitations, she said, “The common pre-existing heart diseases in pregnancy in India are Rheumatic heart disease affecting the cardiac valves, congenital heart diseases followed by peri partum cardiomyopathy and ischaemic heart disease. It is very important to have pre- pregnancy consultation with the obstetrician and cardiologist. The evaluation of the heart function before planning pregnancy, review of medicines and optimizing the dosage in view of fetal safety is necessary.”
She concluded, “The clear discussion about the risk to mother’s immediate and long term health and life, risks to the unborn baby in the form of miscarriages, risk of transmission of heart conditions in congenital heart defects, prematurity, need to deliver at tertiary center, financial implications, should happen between the mother, family and doctors. In some heart diseases pregnancy will be like a death sentence hence should be avoided. So, the heart disease in pregnancy require individualized institutionalised care along with close monitoring of the pregnant women and developing foetus.”
