Pregnancy and cardiomyopathy. What newborn baby needs after birth? 6
What can a woman with heart disease do to plan the pregnancy? What should she do during her pregnancy to ensure the health of the mother and her future child? If we go one step further and we consider dilated cardiomyopathy. Within the same group of diseases with the same name, you may have very different things. The first example could be a woman whose father just died from dilated cardiomyopathy. The family was studied; she has a normal heart ultrasound. But she’s carrying the gene for cardiomyopathy. Or she might be at risk of having rhythm abnormality if she’s pregnant. But it’s very unlikely that she’s going to have heart failure. However, her father just died of cardiomyopathy, and sudden death is possible. Dr. Anton Titov, MD. There will be a lot of diagnostic workup by the cardiologist before pregnancy. It’s important to know whether she needs an implantable defibrillator, whether she needs beta-blockers [medications] or not. This is the job of the cardiologist. But usually, things are going to be okay. At the other end of the spectrum, you’ve got the same cardiomyopathy gene, the same disease, but a very poor heart function and a very high risk of sudden death due to ventricular fibrillation. In this situation, if it occurs and presents like this, it will be very important that a woman be aware that pregnancy may cause death. The situation will be different. Dr. Anton Titov, MD. There could be a mid-point scenario. You have a patient with a very moderate alteration of her ventricular function. Maybe she already has an implantable defibrillator. Dr. Anton Titov, MD. So we do not fear a sudden death. Then the situation will certainly be better. But we will need very careful monitoring throughout pregnancy. Usually, those patients may require medicines. For example, they may require to be beta-blockers, which may have an impact on fetal growth. Babies born to mothers taking beta-blockers are usually a little small for gestational age [SGA]. But this does not impact their development in the long run. But this means that we’re going to follow their growth by fetal ultrasound more carefully. Sometimes the birth is induced a little bit earlier because we believe the baby will thrive more outside the mom’s uterus than inside. Dr. Marc Dommergues. Medical second opinion. And in the neonatal period, we’ll need to focus on the baby’s health. You need to check for hypoglycemia, for example, low blood glucose or low blood pressure in the baby, which may be the consequence of having being exposed inside the mother’s uterus to those medications. In contrast, there’s very little risk of having malformations due to these medications. Another issue then will be the genetic transmission of cardiomyopathy. It’s important that people know that there’s a 1 in 2 risks of transmitting the cardiomyopathy gene. But how this gene is going to be expressed? What the heart disease symptoms will be? Will the child have a heart problem at 30 or 80 years of age? It’s impossible to predict. This is difficult genetic counseling. Obviously, we need the help of the geneticists in addition to the help of the cardiologists, pediatricians, anesthetists to manage this pregnancy. Dr. Anton Titov, MD. So these are examples [of managing pregnancy when a mother has a heart disease]. You could have a huge number of different examples, of course, because cardiology is a very vast area. It shows you how different management may be. Dr. Marc Dommergues. Medical second opinion. And how the most important thing in the whole story is good communication between all professionals. In our group, it took us time to understand how we could speak to each other, how we could find a common language between obstetricians, anesthetists, pediatricians, and cardiologists. But hopefully, we succeeded now. Dr. Marc Dommergues. We are very happy with it! But it’s a question of speaking out and being able to communicate despite the silos of medical disciplines. Of course, it’s important to break across the silos of disciplines. What I hear communication is key to the successful management of any medical problem. It is certain.
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