Pregnancy is   the   most cherished part of life of a woman.  Every woman after a certain age desires to have a baby of her own.

This is a natural instinct to procreate.  A normal pregnancy and child birth   usually goes smoothly with no problem.  But in a woman with heart disease, pregnancy can become problematic for both the mother and baby. Hence these women need special care and attention.

During pregnancy, there are changes in    heart and circulatory system due to hormonal changes. There is increase in the heart rate, increase in output of blood from the heart and increased thickness of blood.

These changes tend to precipitate heart   diseases in women who are prone to it. Those suffering from pre-existing heart related problems have   aggravation of this problem   during pregnancy.

In both situations it can become a grave problem for both the mother and baby.

Therefore it is important for the women to be aware of risks associated with pregnancy in presence of cardiac problems.

Hypertension is one such problem. In case of women suffering from hypertension, it is of utmost importance to keep the blood pressure under control during pregnancy. Otherwise due to the physiological changes occurring during pregnancy, the blood pressure may become very high resulting in intrauterine death of the foetus.

Some women develop hypertension only during pregnancy, a condition known as eclampsia of pregnancy. This is a life threatening condition needing urgent treatment.

 In those having   diseases of the heart valve like mitral or aortic stenosis, pregnancy is a situation which can precipitate or aggravate cardiac failure.

Due to better life style conditions and management,   many children with congenital heart disease survive   up to adulthood.

These women need special attention during pregnancy and delivery. Some women develop damage to the heart muscle during or immediately after delivery, a condition known as peripartum or post partum cardiomyopathy.

This in turn precipitates cardiac failure, with the classic manifestations of swelling over feet and body and breathlessness.

Heart failure can also be precipitated or aggravated in women who suffer from uncontrolled diabetes mellitus during pregnancy.

Obesity is yet another factor causing hypertension and cardiac problems during pregnancy.

Due to more women opting for higher education and career, the age at which they conceive is usually much higher.  This puts them at greater risk of   factors causing   heart diseases.

Because the thickness of blood is increased during pregnancy, there is increased risk of forming of blood clots. Formation of clots in the vessels of lower limbs leads to pain in the calf muscles and or entire leg. 

Peace of a clot can detach and pass in the circulation of brain causing stroke or in the heart resulting in myocardial infarction.

If a pregnant lady starts suffering from chest pain, palpitations on exertion, breathlessness on walking,  exertional chest pain, syncopal attacks, with or without swelling over feet,  she should be investigated for a  cardiac problem.

Those who have a cardiac problem existing before getting pregnant have to be very careful to see that the condition is not worsened.

Good control of hypertension or diabetes ensures   prevention of cardiac failure during pregnancy. One has to be compliant with the medicines prescribed.

Alcohol and cigarette smoking should be avoided. Regular physical exercise suitable for the pregnant state is important for prevention of cardiac problems. 

It is also important to maintain a diet with low salt and fat to avoid obesity, hypertension as well as cardiac failure.

With just these precautions and little care a woman can prevent development and aggravation of cardiac problems.  If a problem does develop, she is advised to take rest and avoid exertion to minimize the symptoms along with other treatment. Usually at the discretion of a treating doctor, elective caesarean section is done to ensure safety of the mother and baby.

Thus a lady with heart diseases can enjoy pregnancy and motherhood. Only thing needed is that she has to take some precautions.

rachna212002@yahoo.co.uk
The author is a Specialist in Internal medicine-Ruhengeri Hospital