Congenital heart defects: What precautions should young parents take to protect their unborn child from coronary artery disease?

By Dr. Pankaj Sugaonkar,

Heart disease is the number one cause of death in India, but did you know that many heart or heart diseases can exist from birth? These conditions fall under the umbrella term of congenital heart defects (CHD). Congenital simply means “present since birth”. Nearly 30% of birth defects are due to coronary heart disease and occur in 8-12 out of every 1,000 live births. and the children themselves. Significant advances in pediatric cardiac care have improved the survival of many babies with coronary artery disease. However, 10% of all infant deaths in India are due to coronary heart disease.

What is CHD?

The baby’s heart is divided into four chambers. The two smaller upper chambers are called atria and are divided by a thin wall called the atrial septum. The lower two larger ones are called ventricles and are separated by the ventricular septum. Blood flow in the heart takes place in one direction and is controlled by gates called valves. Any problem with the development of the heart in the mother’s womb can lead to coronary heart disease. Depending on whether or not the defect affects the baby’s blood oxygen levels, coronary artery disease is of two main types: acyanotic (60-70%; normal babies) and cyanotic (30-40%; blue babies). In acyanotic coronary artery disease, there is enough oxygen in the baby’s blood, but it circulates abnormally. Some examples include ventricular or atrial septal defects (hole in the atrial or ventricular septum) or persistent ductus arteriosus (PDA; occurring in premature babies). In PDA, there is an abnormal connection between the major blood vessels of the heart, the aorta and the pulmonary artery. Cyanotic coronary artery disease is a more serious condition in which the baby’s body takes on a bluish tint due to insufficient oxygen supply. One of these conditions is transposition of the great vessels in the heart where the pulmonary artery and aorta are switched.

What precautions can parents take to protect the heart of their unborn child?

Some common precautions taken during pregnancy that can help reduce the risk of coronary heart disease include

  • Appropriate age and weight of the mother when she conceives
  • Adequate folic acid supplementation
  • Avoid smoking and drinking (even passive smoking can be dangerous)
  • Maintaining excellent blood pressure in women with diabetes or gestational diabetes
  • Avoiding medications that may interfere with the baby’s development or come into contact with radiation, pesticides, or other harmful chemicals
  • Make sure vaccinations are up to date (since viral infections like rubella or German measles can cause coronary heart disease)

On the other hand, certain genetic factors such as consanguineous marriages can also increase the risk of coronary heart disease. Also, for parents who already have a child with coronary artery disease, the chance of having a second child with coronary artery disease is 3%. These parents need to mentally prepare for this higher probability. Overall, having a planned rather than an accidental pregnancy can help the doctor and parents plan things out better.

Can coronary artery disease be detected during pregnancy?

Yes, fetal echocardiography at 18-20 weeks (5e months) of pregnancy can help detect most coronary artery disease in the uterus itself. This can help parents and the medical team prepare for the baby’s special needs after birth.

What are the symptoms of coronary artery disease?

The onset of symptoms depends on the severity of coronary artery disease. Symptoms of acyanotic coronary artery disease in newborns include repeated respiratory infections, lack of weight gain, and poor diet. Less severe forms may present later in childhood as difficulty breathing, fatigue on exertion, and fainting. The main symptom seen after birth in babies with cyanotic coronary artery disease is bluish discoloration of the baby’s fingernails, lips, tongue and toes, along with no increase in weight and height.

How have technological improvements in treatment reduced infant mortality from coronary artery disease?

Early diagnosis is the key to successful treatment. Over the past few decades, treatment options for babies with coronary artery disease have improved dramatically. Depending on the severity of coronary artery disease, options include medications, minimally invasive procedures, and surgery. For cyanotic coronary artery disease, surgery is the main option, but technological improvements have greatly increased the chances of survival. In acyanotic coronary artery disease, survival rates have approached 100% since minimally invasive procedures have become available. For example, an umbrella-like device can be inserted through a small incision in the leg to seal the baby’s atrial/ventricular septal defect. Even in the case of the PDA, a small button-like device is available to seal the hole. Most importantly, after such procedures, patients recover in 2-3 days and show significant improvement. However, follow-up appointments for all procedures are very important.

Huge technological improvements have made the early detection and successful treatment of coronary heart disease a reality. Regardless of when coronary artery disease is detected, during pregnancy or after the baby is born, parents can rest assured that cutting-edge treatment is available. So follow your doctor’s precautions and instructions and don’t hesitate to seek help in a timely manner.

(The author is a Consultant Pediatric Interventional Cardiologist, Little Heart, Pune. The article is for informational purposes only. Please consult medical experts and healthcare professionals before commencing any therapy, medication and/or remedy. Opinions expressed are personal and do not reflect the official position or policy of Financial Express Online.)