AHA guidelines aim to help women with congenital heart disease have successful pregnancies

The American Heart Association (AHA) has published new guidelines for physicians when caring for women with congenital heart disease hoping to have a baby.

The guidelines, published in Circulation, will help women with the heart condition have successful pregnancies. In previous generations, physicians generally warned against women with congenital heart disease to have children because the stress on their body would be too difficult to bear.

The guidelines—with recommendations for women before and during pregnancy, during delivery and after the baby is born—were written by a focus group chaired by Mary Cannobbio, a nurse at Ronald Reagan UCLA Medical Center and lecturer at the UCLA School of Nursing.

"There is a burgeoning group of women born with complex congenital heart disease who are now of childbearing age and want to get pregnant," Canobbio said in a statement. "The problem is, pregnancy in this population is very risky. We really didn't have any data to refer to in order to help them make safe, informed decisions. So I went on a mission to see if we could come up with some definitive answers for these women about the likelihood of becoming pregnant and steps we might need to take to help them deliver their babies safely."

To create the guidelines, she analyzed data from hundreds of colleagues, taking useful information from successful pregnancies and approaches that were in place for high-risk patients.

"We found that if women's heart health is stable at the onset, we can get them through pregnancy," Canobbio said. "But that doesn't mean they're not at risk for complications. We need to have a lot of people in place in order to ensure that we manage their care at an optimum level, at every stage."

The guidelines advise patients to undergo extensive counseling with a cardiologist and an OB-GYN who specializes in high-risk pregnancies. If needed, doctors can also refer patients to genetic counseling and give them routine electrocardiograms, echocardiograms and exercise stress tests to assess their physical condition.

During pregnancy, patients should be monitored closely by an OB-GYN, cardiologist and specialist in maternal-fetal medicine. When the patient is getting close to delivering the baby, she needs to have a birth plan that all doctors involved can agreed on. Additionally, a heart surgeon should be available during the delivery.

"The burden of pregnancy is huge," Canobbio said. "We want each woman to understand the risks before she ever considers pregnancy, and understand the effect it might have on her heart in the long run."