Pregnancy advice in congenital heart disease needed

WOMEN with congenital heart disease (CHD) should be reminded of the need for specialist evaluation if they plan a pregnancy, a leading obstetrician says.

While in the past women with CHD were often told not to have children, medical advances meant most could have successful pregnancies with careful management of anaesthesia and delivery, Dr Christine Tippett, president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said.

Dr Tippett was commenting on a Canadian study suggesting that women with CHD were poorly advised about pregnancy risk.

While 18 women in the cohort of 116 with CHD would currently be advised to avoid pregnancy, only half recalled being told this.

It was unknown if Australian women were similarly poorly advised, as “no-one has looked”, Dr Tippett said.

“A lot of young women who have had successful surgery for CHD as children now lead active normal lives and... [the disease] may not be on their radar.”

However, CHD covered a broad spectrum from simple ventricular septal defects to diagnoses with more serious implications such as tetralogy of Fallot.

Pregnancy and childbirth could cause exacerbation of previous cardiac compromise and women with CHD would be well advised to seek both cardiologists and obstetricians with expertise in management of high-risk pregnancies, she said.

J Am Coll Cardiol 2008;52: 577-78.