The American Heart Association published the scientific statement “Management of Pregnancy in Patients with Complex Congenital Heart Disease” (Circulation, 2017). The statement acknowledges that for many women with complex congenital heart disease, carrying a pregnancy carries a moderate to high risk for both the mother and her fetus. The authors also reinforce the importance that all practitioners who will be manage the care for women with a CHD have current information not only on preconception counseling and diagnostic evaluation to determine maternal and fetal risk but also on how to manage them once they are pregnant and when to refer them to a regional center with
expertise in pregnancy management.
Topic #2 of 6: Planning a Healthy Pregnancy (sharable version attached)
Women living with a congenital heart defect (CHD) can have healthy pregnancies. Plan ahead and follow these steps.
- See health care professionals who treat pregnant women with CHDs. You should have a congenital cardiologist, a high-risk obstetrician, an anesthesiologist and a social worker on your medical team.
- Go to your appointments. Your cardiology health care professionals will tell you how often appointments with them are needed. Most women with a CHD see their congenital cardiologist at least once each trimester.
- Take vitamins with folic acid, eat healthy foods, exercise, get enough rest, don’t smoke, and don’t drink alcohol. Also, only take drugs prescribed by your doctors.
During pregnancy, the congenital cardiologist may want to perform special tests.
- Most women with a CHD have ultrasounds of their heart, called “echocardiograms.” These are usually done early in the pregnancy and in the third trimester.
- An ultrasound – fetal echocardiogram – of the baby’s heart should also be performed around 18-20 weeks of pregnancy to check for a CHD in the baby.
During the pregnancy, plans for labor and delivery will be made.
- The anesthesiologist will talk with you about pain control options because some of these medicines can affect the heart rate and blood pressure.
- A vaginal delivery is recommended for most women with a CHD but this is an individual decision and varies depending on the patient and the type of CHD. The obstetrician and congenital cardiologist will let you know what type of delivery will be recommended for you.
Additional information about reproductive health for (young) women living with a CHD is available from the Congenital Heart Public Health Consortium through the HealthyChildren.org Website.
CDC researchers found that the cost of hospitalizations linked to birth defects in the US totaled $22.9 billion or 5.2% of total health care costs in 2013, while representing only 3% of all hospitalizations. The findings were published in the agency’s Morbidity and Mortality Weekly Report. Costs were particularly high for hospitalizations related to congenital heart defects, which cost more than $6 billion in 2013. Key findings are summarized on the CDC website.
Birth defects are the leading cause of infant death in the United States, accounting for about 1 in 5 infant deaths. In this study, researchers looked at the number of infant deaths related to birth defects per 1,000 live births for infants whose deliveries were paid by Medicaid or private health insurance. CDC researchers estimated that approximately 12 infant deaths related to birth defects occurred for every 10,000 babies born in the United States from 2011-2013.
Death rates related to birth defects were higher for babies whose deliveries were paid by Medicaid compared to private insurance. Further study is needed to identify the underlying reasons for these differences. Strategies to ensure that all pregnant women and their infants have access to high quality health care might reduce the difference in infant mortality between deliveries paid by Medicaid and those paid by private insurance. We invite you to read the full article.
· The three most common categories of birth defects listed as a cause of death: central nervous system (CNS) defects, congenital heart defects (CHD) and chromosomal abnormalities.
· Approximately 15% of all infant deaths and 70% of infant mortality attributable to birth defects (IMBD) occurred in the neonatal period. CNS defects, CHD, and chromosomal abnormalities accounted for 57% of neonatal and 76% of postneonatal IMBD.
· Among preterm births, postneonatal mortality for deliveries covered by Medicaid was 40% higher for CHD and 81% higher for chromosomal abnormalities, compared with those covered by private insurance.
You can find the Morbidity and Mortality Weekly Report (MMWR) article on this subject matter by clicking on: https://www.cdc.gov/mmwr/volumes/66/wr/mm6603a4.htm?s_cid=mm6603a4_e.
What You Can Do
Spread the word about this study! We encourage you to share these links with your colleagues and friends. Feel free to post them on your own home page as well. Please share on your social media channels or share/retweet/favorite from @CDC_NCBDDD.
For More Information:
Birth Defects: https://www.cdc.gov/ncbddd/birthdefects/facts.html
This research was done in collaboration with The March of Dimes. We thank them for their continued support and partnership.
Get your cameras out because for the fourth year in a row, Mended Little Hearts is hosting its Rock Your Scar (#RockYourScar) photo contest and awareness campaign. For many teens and tweens, it is the very first time they have seen other teens and tweens just like them, and it makes them feel less different and alone. No physical scars are required—just show how you are embracing your CHD and not letting it limit or define you. If you don’t want to enter the contest, you can still post your pictures to Mended Little Hearts’ Facebook event and create greater awareness. Photos in the contest will be judged by a selected panel on quality, creativity, originality and demonstrating the theme. To enter, or for more details, visit www.mendedlittlehearts.org.
Birth defects are common, costly, and critical. Every 4 ½ minutes a baby is born with a major birth defect in the United States. Become an active participant in National Birth Defects Prevention Month by joining the nationwide effort to raise awareness of birth defects, their causes and their impact.
Infections during pregnancy can hurt both mothers and their babies. We encourage all women to make healthy choices and learn different strategies to prevent infections during pregnancy to help lower their risk of having a baby born with a birth defect. This year we are encouraging all women to prevent infections to protect their babies by observing the following guidelines:
o Properly prepare food.
o Talk to your healthcare provider.
o Protect yourself from animals and insects known to carry diseases such as Zika virus.
o Maintain good hygiene.
Women and their loved ones can participate in these strategies and take these important steps toward a healthy pregnancy. Share your own tips for a healthy pregnancy using #Prevent2Protect on social media. Learn more at http://www.nbdpn.org/bdpm.php#PreventToProtect
Topic #2 of 6: Preconception Counseling (sharable version attached)
Pregnancy is hard on the heart. However, most women with a congenital heart defect (CHD) are able to have healthy pregnancies if they choose. If you have a CHD and are thinking of having a baby, make an appointment first with a congenital cardiologist who treats adults with CHDs. The congenital cardiologist can help you determine if pregnancy is a safe option for you.
It will be important to tell the congenital cardiologist about any cardiac symptoms you have experienced. These include chest pain or feeling out of breath, tired or dizzy. You should also tell the doctor if you have felt heart palpitations that might make your heart feel like it is pounding, fluttering or beating too fast.
You will probably receive an echocardiogram – an ultrasound of the heart – to look for any heart problems. Some problems can be treated before becoming pregnant.
Occasionally, congenital cardiologists have to tell their patients that becoming pregnant would be very high risk for their heart or for the baby. If this happens to you, your doctors can help you and your partner understand the risks and learn about other possible choices for having a family such as surrogacy or adoption.
If your congenital cardiologist gives you the okay to become pregnant, you should consider the baby’s health, too. Babies of parents with a CHD are more likely to be born with a CHD. A genetic counselor or geneticist can discuss testing and discuss the risks of your child having a CHD. Additional information about preconception counseling and reproductive health for young women living with a CHD is available from the Congenital Heart Public Health Consortium through the HealthyChildren.org Website. Follow this conversation on Twitter at #CHDCare4Life.
When you have a congenital heart defect (CHD), choosing the right type of birth control can mean the difference between protecting your heart and developing serious health complications.
Many oral birth control medications contain a hormone called estrogen, which can increase a person’s chance of having a stroke or developing blood clots. Birth control with estrogen is not recommended if you are at risk of forming blood clots. This is especially the case if you are a CHD patient with an artificial heart valve or you have had a Fontan operation.
If you are at risk of developing blood clots, you might want to consider one of the following birth control methods:
- Birth control that contains only the hormone progestin. It is available as an oral medication, an implant, an injection or an intrauterine device (IUD).
- Barrier methods, such as condoms and diaphragms.
If you have been told you could have a very high-risk pregnancy, be sure to use a reliable form of birth control, such as an IUD, or even two forms of birth control. And if you have decided never to become pregnant, you or your partner might want to consider permanent sterilization. This does not mean that you cannot have a family; talk to your health care providers about other options for having a family, including surrogacy or adoption.
It is always best to talk to your cardiologist and gynecologist about the different types of birth control and which form is recommended for you. Additional information about contraception and reproductive health for young women living with a CHD is available from the Congenital Heart Public Health Consortium through the HealthyChildren.org Website.
This article was developed by the Congenital Heart Public Health Consortium (CHPHC) as part of a continuing series on how women with a congenital heart defect (CHD) can manage issues related to reproduction and parenting. For more information or to read the other topics in the series, please visit the Congenital Public Health Consortium website
The CHPHC is a group of organizations who have united their resources in an effort to prevent congenital heart defects and improve the lives of those adults and children affected by the disease. The CHPHC is supported by the cooperative agreement number, 5 U38 OT000183, between the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Additional information about the CHPHC is available online at www.chphc.org. The publications and other output of the CHPHC are solely the responsibility of the authors and do not necessarily represent the official views of the American Academy of Pediatrics, Centers for Disease Control and Prevention or the Department of Health and Human Services.
“Essentials for Parenting Toddlers and Preschoolers” is a free, online resource developed by the CDC to help parents learn skills that form the foundation of a positive parent-child relationship. Skills focus on encouraging good behavior, while decreasing misbehavior using proven strategies.
In the article “Databases for Congenital Heart Public Health Studies Across the Lifespan (JAHA, published online October, 26, 2016), the authors representing the Congenital Heart Public Health Consortium (CHPHC) advocate that anyone planning studies to address public health knowledge gaps may benefit from an understanding of the complex constellation of databases with congenital heart defect (CHD) data. The article provides a summary of the database categories with examples. Included are administrative healthcare databases, surveillance, clinical databases or registries, as well as surveys and vital records. Also discussed are opportunities to leverage databases through linkage as an important tool to understanding long-term and longitudinal outcomes for persons with CHD. Share your perspective on this topic by adding to the discussion on CHPHC Collaborate.