“Discussions (on pregnancy) must start at an early age as it will make it easier for the patient to plan their future…at the very least, they can seek the best advice in planning and managing their pregnancy, as well as after- delivery care,” she said.

Besides congenital heart disease, many women in Malaysia also have valvular heart disease such as rheumatic heart disease. Valvular heart disease occurs when any one of the four valves in the heart is damaged or diseased. The valve can either be repaired or replaced with an artificial valve.

Pregnant women whose damaged valve has been replaced with a mechanical valve face higher risks and have to take blood-thinning medication like warfarin.

Lately, there has also been a rise in cardiomyopathy cases caused by weakened heart muscle, which can occur due to various factors such as genetics, infections and other diseases, explained Dr Geetha.

Data from the Malaysian Confidential Enquiry into Maternal Deaths show that heart disease is the commonest cause of indirect maternal deaths and can be classified more specifically as valvular heart disease, congenital heart disease and cardiomyopathy.

“Pre-pregnancy counselling is absolutely crucial because from there, we can conduct all the relevant tests to determine the type and level of risk faced by the patient. This will make it easier for the specialist to decide on the best medical strategy for the mother and the baby,” she added.

Risk Groups

Cardiologists basically categorise women with heart disease into four risk groups. The women in the first and second modified WHO (World Health Organisation) cardiovascular risk groups face low to medium risk, and cardiovascular specialists and gynaecologists will give them the go-ahead to conceive.

For those in the third and fourth groups, explained Dr Geetha, it would hinge on the type of disease and the patient’s heart condition.

“If her valve is moderately narrow, or she has an artificial valve made of metal, or has cyanotic heart disease (low blood oxygen level), or her heart is not functioning well, she can still become pregnant but would need to be monitored strictly by specialists who are skilled in caring for high-risk pregnant women.”

Women in the third group will not only be required to undergo pre-pregnancy counselling, but will also require specific medication and treatment, and there may even be times when they have to be warded in the hospital for close monitoring.

Meanwhile, women in the fourth group are advised to avoid pregnancy due to the high risks involved.

But this fourth group can be subdivided into two categories, with the women in the first category not allowed to become pregnant unless they have undergone treatment for their heart disease, while for those in the second category, pregnancy is totally out of the question.

“Women are not allowed to become pregnant if their heart is weak (functioning at less than 30%) or there is no treatment to improve their heart condition.

“High or abnormal lung pressure can also endanger the life of the patient if she becomes pregnant,” said Dr Geetha.

Women in the third and fourth groups also face a higher risk of miscarriage, premature birth and improper development of the foetus, she said, adding that the baby also faces the risk of being born with congenital heart disease.

Media Contact
John Mathews
Journal Manager
Current Trends in Cardiology
Email: cardiologyres@eclinicalsci.com