Pregnancy and congenital heart diseaseBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.38756.482882.DE (Published 16 February 2006) Cite this as: BMJ 2006;332:401
- Anselm Uebing, fellow in adult congenital heart disease1,
- Philip J Steer, professor of obstetrics and gynaecology2,
- Steve M Yentis, consultant anaesthetist3,
- Michael A Gatzoulis, professor of cardiology, congenital heart disease (email@example.com)1
- 1 Adult Congenital Heart Disease Unit, Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute at Imperial College, London SW3 6NP
- 2 Academic Department of Obstetrics and Gynaecology at Chelsea and Westminster Hospital, Division of Surgery, Oncology, Reproductive Medicine and Anaesthetics, Faculty of Medicine, Imperial College, London
- 3 Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster Hospital, London
- Correspondence to: M A Gatzoulis
- Accepted 11 January 2006
Congenital heart disease occurs in 0.8% of newborn infants around the world. Advances in medical and surgical treatments over the past decades has led to more than 85% of these infants surviving to adulthood.1 2 Most interventions, however, have not been curative and about half of adults with congenital heart disease face the prospect of further surgery, arrhythmia, heart failure, and—if managed inappropriately—premature death. The burden of pregnancy represents a new challenge in women with congenital heart disease.
In the United Kingdom about 250 000 adults have congenital heart disease (also known as “grown up congenital heart disease (GUCH)” patients), and this number is growing.3 Half of these patients are women, most of reproductive age. After suicide, cardiac disease is now the leading cause of maternal death in the UK, with most of these casualties having had congenital heart disease.4 The medical profession should therefore be aware of the risks that women with congenital heart disease face during pregnancy so that they can be given adequate preconception counselling and optimal care during pregnancy, delivery, and the postpartum period.5–7
Discussions about future pregnancies, family planning, and contraception should begin in adolescence to prevent accidental and potentially dangerous pregnancies in women with congenital heart disease. The impact of heart disease on childbearing potential needs to be explained clearly and sympathetically. Counselling has to address how pregnancy may affect not just the mother but also the fetus and the rest of the family (box 1). This allows women to make an informed choice whether they wish to accept the risks associated with pregnancy. The counselling should ideally be provided in a joint clinic by an obstetrician with expertise in heart disease and a cardiologist with special training in adult congenital heart disease.
The risk for the mother
The risk for pregnant women …