Women with heart defects have significantly more cardiovascular problems during pregnancy than those without, but only half of them get a recommended test to assess their heart health before giving birth, new study finds .
The study, published Monday in the journal American Heart Association Circulation: cardiovascular quality and results, found that during pregnancy, women with congenital heart disease had unwanted conditions 34 to 63 times more often than those without a heart defect. The conditions included high blood pressure in the lungs, heart rate problems, dangerous heart rhythms, and cardiac arrest. But only 56% of those women received the full echocardiograms recommended by the experts.
“We were surprised that some conditions were up to 63 times more prevalent,” said lead author Karrie Finn Downing, epidemiologist in the Birth Defects and Childhood Disorders Division of the Centers for Disease Control and Prevention. âWomen with coronary artery disease and their doctors need to be aware of this higher level of risk so that there is more communication between the two during pregnancy. They need echocardiograms to assess heart health and identify any problems. at the start of pregnancy. “
In the United States, approximately 40,000 babies are born each year with congenital heart defects, a disease that affects the structure of the heart and the way blood circulates in the rest of the body. These defects can be fatal. However, a growing number of people born with coronary artery disease are living longer and healthier lives.
Researchers estimate that there are now about 1.4 million American adults living with coronary heart disease. So more and more women with the disease are living long enough to start a family, and as they do, hospital deliveries for pregnant women with coronary artery disease have increased.
The AHA, the American College of Cardiology, and the American College of Obstetricians and Gynecologists recommend that physicians use echocardiograms as part of a comprehensive assessment of the heart health of these pregnant women. The painless test uses ultrasound to visualize the heartbeat and pump blood to detect abnormalities.
The study did not explain why half of the women who should have had echocardiograms did not.
But one of the reasons may be that some healthcare providers are not aware of the guidelines, said Dr Laxmi Mehta, professor of medicine and director of preventive cardiology and women’s cardiovascular health at Wexner Medical Center. from Ohio State University in Columbus. She recently chaired a panel of experts that drafted an AHA statement recommending that pregnant women with heart problems receive specialized treatment from a collaborative team, including an obstetrician, cardiologist, anesthesiologist, specialist in heart disease. maternal and fetal medicine and nurses.
As women with coronary heart disease grow older and move from seeing pediatricians to adult health care providers, “some may lose their cardiologist,” said Mehta, who was not a member of the new study.
“They may be followed by a primary care physician and obstetrician, or be cared for by a midwife who may not have formal training in coronary heart disease or who is unaware of recommended cardiac guidelines. . Just because guidelines exist doesn’t mean they’re being implemented. We need to increase education about these guidelines for the entire health care team so that patients with severe coronary artery disease and less severe receive the care recommended by the guidelines before, during and after pregnancy. â
While not getting an echocardiogram may not lead to worse outcomes for some pregnant women, it could delay the identification of issues that are affecting the health of the mother, she said.
âThose who are not assessed on time could experience a delay in recognizing problems such as heart failure or worsening underlying valve disease. Pulmonary hypertension could get worse,â Mehta said . “Even if they have an echocardiogram, these things can happen. But close monitoring means the sooner you catch it, the sooner you can fix it by adjusting medications and birth plans.”
Pregnant women with CVD need specialized care before, during and after childbirth
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