In February 2017, London-based actress and comedian Rebecca Shorrocks was diagnosed with arrhythmogenic cardiomyopathy (irregular heartbeat), a genetic condition with a 50 per cent chance of passing from parents to children.
The diagnosis overwhelmed Shorrocks, who was planning to conceive. After consulting doctors and experts, she mulled over in-vitro fertilisation through which doctors could eliminate the genetic strand responsible for this condition.
“Doctors never advised me against pregnancy. They informed us that the child would have a 50-50 chance of developing the condition,” says 40-year-old Rebecca Shorrocks.
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However, after extensive deliberation, she decided to conceive naturally. Both she and her daughter Dot are hale and healthy. The initial cardiac examination has ruled out any complications in Dot. She will undergo a genetic diagnosis after she turns 12 as per English law.
Pregnancy planning and heart health
Experts point out that during pregnancy, the expectant mother’s heart would be under tremendous strain as it must pump a high volume of blood to provide nutrition to the baby.
Dr Rajpal Singh, director, interventional cardiology and heart failure, Fortis Hospital, Bengaluru, says that certain cardiac complications in the mother could lead to teratogenic effects (abnormal fetal development). In-depth counselling with specialists (cardiologists and gynecologists) can help in risk assessment and management.
There are some heart conditions like pulmonary hypertension where pregnancy is not advised, says Dr Smrithi D Nayak, consultant, obstetrics and gynecology, Aster RV Hospital, Bengaluru.
Some of the heart conditions which could impact pregnancy include:
Pulmonary hypertension occurs when there is high blood pressure in the arteries that carry blood from the heart to the lungs.
Dr Singh says that severe blood pressure due to pulmonary hypertension increases the risk of congenital abnormalities. He further says women with pulmonary hypertension must consult a cardiologist and an obstetrician to decide whether the pregnancy is safe or not.
Congenital heart disease
It refers to the range of heart defects that are present from birth. It can range from mild to dangerous. Dr Nayak points out that mothers who have congenital heart diseases require an assessment to estimate if the genetic condition can be passed on to the child as well. This will enable one to analyse the risk involved in pregnancy.
This is a heart muscle weakness disorder that could arise mostly in the final months of pregnancy or up to five months after giving birth. Dr Nayak cautions that it is a risky condition where the heart gets enlarged. It could have a long-lasting impact and slowly lead to heart failure. She further says if a woman has faced this issue in her first pregnancy, it is not recommended to have another pregnancy, because there is a high chance that it will recur.
Heart valve disease
Heart valve disease is a condition where one or more valves (out of the four) in the heart are not functioning well. Dr Nayak says that people with this condition are put on anticoagulants to prevent the formation of clots. Pregnant women are given safer anticoagulants that will not affect the fetus.
Dr Pravin Kahale, consultant, cardiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, cautions that increased blood flow during pregnancy may put pressure on the heart if the valves aren’t functioning well, resulting in endocarditis and heart valve infections, which can have grave effects on the health of both the mother and the child.
Arrhythmia or irregular heartbeat
Dr Kahale says that pregnancy increases the mother’s risk of developing an arrhythmia despite having no history of the condition.
Supraventricular tachycardia (SVT – irregularly fast heartbeat) and ectopic heartbeat (extra or missed heartbeats) are the two types of arrhythmias that are mostly seen in pregnant women. Minor heart rhythm irregularities are frequent during pregnancy and are not usually a cause for concern.
Dr Singh says that heart function must be monitored for at least a year after cardiac transplantation. The recipients will be on immunosuppressants to reduce the risk of the donor heart getting rejected by the body’s immune system. Pregnancy is advisable only a year after transplantation.
The blood-pumping ability of the heart could be seriously affected after a heart attack. Dr Singh suggests that those women planning to get pregnant after suffering a heart attack should check their ejection fraction (pumping rate).
“If the ejection fraction is within the normal range, pregnancy is not an issue,” adds Dr Singh. He points out that pregnancy is not advisable for a year after one has had a heart attack.
Pregnancy and cardiac complications could be a tough combo. Doctors point out that expectant mothers with cardiac issues should opt for counselling with both a gynecologist and a cardiologist to chart out a healthy and safe pregnancy plan.