Pregnancy and Women with Congenital Heart Disease Overview: ACHD, women heart disease, women heart health, planning pregnancy, delivery, hospitalisation, risk assessment, healthy lifestyle, cardiac-obstetric clinic, sgh

Pregnancy and Women with Congenital Heart Disease - What it is

Congenital heart disease refers to heart defects that exist since birth. The incidence of congenital heart disease in Singapore is 0.8 per cent of total live births. Improvements in the modern medicine in the past decades have increased the survival of patients with congenital heart disease. As such, although women with congenital heart disease will have a higher risk of developing complications – anemia, bleeding, high blood pressure and premature birth – during pregnancy and delivery, most can still have a successful pregnancy, as long as there are careful planning and discussion.

Pregnancy and Delivery for Women with Congenital Heart Disease

Planning pregnancy

Please consult with your cardiologist if you are considering pregnancy. Your cardiologist understands your heart condition(s) and will explain the effect of pregnancy on your health.

Ideally, your pregnancy should be planned before conception. An echocardiogram (ultrasound of the heart) or other tests may be performed to assess if your heart will be able to cope with the extra demand during pregnancy. Your cardiologist will then advise you on the risks and whether pregnancy is safe for you. For some heart conditions, your cardiologist may discuss the timing for surgery to improve your heart function before pregnancy.

It is important for any woman that is planning pregnancy to start observing a healthy lifestyle which includes eating healthily, exercising regularly, avoiding smoking and excessive intake of alcohol.

During pregnancy

There will be an increased demand on your heart during pregnancy. You should visit your obstetrician and cardiologist early, at about six to seven weeks of pregnancy. They will plan your check-ups and scans depending on your heart condition(s). Your cardiologist will listen to your heart and lungs, and ask for symptoms of shortness of breath, irregular heartbeat and exercise tolerance (when climbing the stairs or walking at a normal pace). Your blood pressure and heartbeat will also be measured.

During delivery

Natural birth or vaginal delivery is safe for the majority of women with congenital heart disease. It is important to limit the demand on the heart and thus, good pain relief may be necessary. It is essential to discuss with your obstetrician the various aspects of delivery including the planning and timing of delivery, and the methods of pain relief. For some women, the antibiotic prophylaxis is recommended before labour starts to prevent endocarditis.

Hospitalisation

Women with congenital heart disease may need to have a slightly longer stay in the hospital after their delivery to allow the heart to normalise to pre-pregnancy levels.

Cardiac-Obstetric Clinic

National Heart Centre Singapore (NHCS) and the Department of Obstetrics & Gynaecology from Singapore General Hospital run a monthly specialised joint Cardiac-Obstetric Clinic on the last Monday morning of the month to see all pregnant patients with heart disease. Over the last 10 years, we have managed 200 to 300 pregnant patients with varying severity of cardiac problems through their pregnancy with successful outcomes.