Pregnant Women With Heart Disease Should Give Birth Before Week 40
In terms of medication, pregnant women with heart failure should be treated in the same way as non-pregnant patients, respecting the contraindications to certain medications.
Women with cardiovascular disease who become pregnant should take into account the increased risk of health complications during pregnancy. In order to guide mothers-to-be with coronary problems and the specialists responsible for their treatment, the European Society of Cardiology (ESC) has developed a guideline that addresses all aspects of heart disease in pregnancy.
The European Heart Journal is the journal in which this guideline was published. It contains important recommendations such as the appropriate medication for women with cardiovascular disease during pregnancy, the risks of in vitro fertilization in these patients, the guidelines to be followed during delivery, or how contraception and termination of pregnancy should be carried out if necessary.
One of the recommendations was regarding the maximum duration of her delivery, which they set at 40 weeks. Apparently, as the experts of the ESC explain, there is no additional benefit to the child from this time, but it increases the risk of negative effects on the mother.
Medications To Control Heart Disease In Pregnant Women
In terms of medication, pregnant women with heart failure should be treated the same as non-pregnant patients, respecting the contraindications to certain medications.
Another example of what treatment should be followed in pregnant women with hypertension is that treatment should be initiated when blood pressure levels are consistently greater than or equal to 150/95 mmHg, and greater than 140/90 mmHg when suffering from gestational hypertension, when pre-existing hypertension overlaps with gestational hypertension, or when subclinical organ damage occurs.
The ESC warns that thrombolytic agents for thromboembolism should only be used in the setting of severe shock or hypotension. Although acetylsalicylic acid – or aspirin – is one of the drugs that should not be taken during pregnancy, some studies suggest that it may reduce the risk of preeclampsia, and this guideline recommends that people at moderate or high risk should consume 100 to 150 mg of aspirin daily from week 12 through week 36 or 37 in addition to their regular hypertension treatment.
Single Embryo In Vitro Fertilization (IVF)
Another topic covered in the guidelines is in vitro fertilization. It is important to note that the heavy use of hormones increases the risk of heart failure and thrombosis, so it is necessary to consult a cardiologist before embarking on this procedure. In addition, it is recommended to transfer only one embryo to avoid multiple pregnancies that can put a lot of stress on the heart.
In general, pregnant women are at risk of cardiovascular disease, as they are 100 times more likely to die or suffer from heart failure than healthy pregnant women. Obstetric complications such as pre-eclampsia, preterm labor or postpartum hemorrhage are some of the risks associated with pregnancy in women with heart disease. In addition, between 18% and 30% of babies suffer from complications and 4% of newborns die. Despite these figures, it should be noted that the majority of women with heart disease have healthy pregnancies.
Therefore, the guidelines suggest that women with these health problems should consciously consider pregnancy, and as the document points out, those who decide to use contraceptive methods should consult a cardiologist, as many methods are contraindicated for patients with congenital heart disease.
Medication During Pregnancy
Taking certain medications during pregnancy may cause adverse reactions and endanger the fetus. Let’s detail which ones are dangerous at this stage, and the alternatives you can use.
What Medications Should I Not Take During Pregnancy?
All pregnant women, for one reason or another, are worried about the doubt that the most well-known and commonly used drugs should not be taken during pregnancy. This is the case of
- Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, naproxen and aspirin are not recommended in the last trimester of pregnancy because they inhibit the production of vasodilating prostaglandins, which can alter blood flow to the fetus. In addition, aspirin is a potent inhibitor of platelet function and increases the risk of bleeding during pregnancy and delivery.
- Nicotine patches: They have harmful effects on the fetus, very similar to cigarettes, but much less so. Pregnant smokers are advised to refrain from using patches to quit smoking, and to use them only if they are unable to quit.
- Antihypertensives: Angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II receptor blockers (ARB-II) are completely contraindicated during pregnancy because they are associated with congenital malformations of the fetus, especially renal malformations and problems during pregnancy, although their use is common and their benefits are important outside of pregnancy.
- Anti-diabetic secretions: are totally contraindicated and insulin therapy should be changed if a woman takes them before pregnancy. In fact, they can cause long lasting hypoglycemia that is difficult to control, which can lead to alterations in the fetal nervous system.
- Statins: HMG-CoA reductase inhibitors lower blood cholesterol levels and their use in the population is widespread. during pregnancy and are associated with malformations in the trachea, esophagus, heart and anus of the fetus.
- Cortisone: This corticosteroid derivative can cause characteristic fetal malformations, cleft palate.
- Oral contraceptives: these drugs increase the risk of Down’s syndrome and genital and urinary tract changes in the fetus. In the mother, they increase the risk of early vaginal cancer. Therefore, if a woman treated with birth control pills accidentally becomes pregnant (which is uncommon but possible), treatment should be stopped immediately as directed by her doctor.
- Omeprazole: Although the effects on the fetus are not as dramatic as some of the drugs mentioned above, it should not be taken. There are other antacids that can replace it.
- Bicarbonate: produces metabolic alkalosis, which increases the natural pH of the blood of the mother and fetus.