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Pregnancy and the Heart

"Heart disease and the baby bump"
By: Ma. Jocelyn A. Niere-Quidlat, MD, FPPSPregnancy and the Heart

Scientific advancement has brought a lot of improvement in the management of various medical conditions. When a woman reaches child-bearing age and becomes pregnant, she may encounter associated risks. Such risks may be multiplied if this woman has heart disease. Hence the question: is it safe for a person who has heart disease to become pregnant? 

Some women, despite having heart disease, may expect a good outcome and a pregnancy that may not require special management. Other women have a higher risk; thus, the underlying cause of the heart disease should be corrected first or the pregnancy should be postponed. The incidence of heart disease affecting pregnancy in the Philippines is 0.53-1.36 percent.

Pregnancy, per se, results in cardiovascular changes such as an increase in the blood pumped by the heart, an increase in overall blood volume, and an increase in oxygen consumption. Because of these changes, several healthy pregnant women may have symptoms similar to those who have heart disease such as difficulty of breathing, feeling tired, and light-headedness.

Heart disease may be classified as congenital or acquired. Some congenital heart diseases like aortic stenosis, severe pulmonic stenosis, and Tetralogy of Fallot should be corrected by surgery before a woman becomes pregnant. On the other hand, those with atrial septal defect, ventricular septal defect, or patent ductus arteriosus may be able to become pregnant and go into labor and delivery without complications as long as pulmonary hypertension is not present.

Rheumatic heart disease is common in the Philippines. Cardiac arrhythmia, heart failure, and ischemic heart may occur in these women.

What can women do? Limit physical activity. Different drugs may also be given to these patients depending on the need—e.g. to control arrhythmia. 

Pregnancy may increase the risks for women with heart disease; appropriate medical support will be very helpful to ensure a safe delivery. Counseling prior to the onset of delivery is vital as well. A team of doctors that includes cardiologists, obstetricians, and anaesthesiologists is needed to manage the condition.

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