CHD's Impact on Females
While most women with congenital heart disease can live fulfilling lives and have safe pregnancies, there are some differences that make it important to consult with your physician.
Adolescents with congenital heart disease may start their menstrual cycles, or Menarche, slightly later than girls without CHD. This is especially true in adolescents with cyanosis, a condition in which blood pumped to the body has less oxygen than normal. Women with cyanosis also may be more likely to have irregular periods. Females who have periods that last fewer than five days per week or no periods after age 18 should see a gynecologist to find the cause.
Pregnancy and childbirth produce remarkable changes in every woman's body. These changes can be even more dramatic in women with congenital heart disease, so it is important that you talk with your physician about birth control options and the advisability of becoming pregnant.
There are many appropriate forms of birth control available to you. Discuss with your primary care physician, gynecologist, and cardiologist the best method to use and work together to tailor your birth control to your specific heart problem.
Women with many forms of congenital heart disease can use most methods safely. Most women can use progesterone-only birth control like Depo-provera (the Shot), the Mini Pill or Implanon, but they may cause you to retain fluid. If you are in a single-partner relationship, you may wish to use an Intrauterine device (IUDs), but IUDs are not recommended for women who have multiple sexual partners because they don't protect against sexually transmitted diseases, which can result in endocarditis. In addition, women with complex heart disease, cyanosis or pulmonary hypertension should not use estrogen-containing contraceptive agents like the Pill because they increase the risk of blood clots.
In a small percentage of cases, tubal ligation may be the best option. Because tubal ligation permanently sterilizes a woman, it is the most effective method for preventing pregnancy. There are two methods: a surgical procedure called laparoscope, and a vaginal procedure called Essure.
You have many appropriate options for birth control; ask a cardiologist with expertise in adult congenital heart disease and your gynecologist to find out more information.
Most women with repaired congenital heart disease can have a safe pregnancy with little risk. However, the normal changes of pregnancy, particularly in the second and third trimesters, can worsen symptoms of congestive heart failure and arrhythmias and cause women with no symptoms to develop problems.
Talk to a cardiologist with expertise in adult congenital heart disease before becoming pregnant. A "pre-pregnancy" evaluation will give your doctor time to treat any problems that could arise during your pregnancy. You may also wish to participate in genetic counseling, which helps adults with congenital heart disease to determine the likelihood that their children will also have a heart defect. The chance of having a baby with CHD varies widely based on defect, but genetic counseling can help you address any concerns about starting a family.
Some types of heart disease are considered extremely high risk so pregnancy isn't recommended. These include pulmonary hypertension or severe heart failure. Women who remain cyanotic should also avoid pregnancy because it increases the risk of blood clots and stroke. If you have Eisenmenger's syndrome (cyanosis and pulmonary hypertension), the risk is extremely high for both the mother and her fetus. In many cases, it is best for women to work with a high-risk obstetrician along with a cardiologist familiar with their condition.
Most women with CHD can deliver their babies vaginally, unless they suffer from other complications. A Caesarean section typically isn't necessary just for heart reasons.
Risk to the Baby
A baby whose mother has a congenital heart defect can still have a healthy heart, but it is at a higher risk of heart disease. In these cases, it's often smart to perform an ultrasound called a fetal echocardiogram to check the fetus's heart for possible defects. A specially trained physician can perform the test around the 18th week of pregnancy.