Pregnancy and Women with Congenital Heart Disease

The incidence of congenital heart disease in Singapore is 0.8 per cent of total live births. In the past few decades, improvements in modern medicine have increased the survival of congenital heart disease patients. Thus, it is expected that there will be more patients reaching reproductive age and have the opportunity to consider starting a family. 

There are specific issues that women with congenital heart disease need to be aware of, especially if they are intending or already are pregnant.

Please consult with your cardiologist if you are considering pregnancy. Your cardiologist understands your heart condition(s) and will explain the effect of pregnancy on your health.

Ideally, pregnancy should be planned before conception. An echocardiogram (ultrasound of the heart) or other tests may be performed to assess if your heart will be able to cope with the extra demand during pregnancy. Your cardiologist will then advise you on the risk and whether pregnancy is safe for you. For some heart conditions, your cardiologist may discuss the timing for surgery to improve your heart function before pregnancy.

It is important for any woman thinking of becoming pregnant to start observing a healthy lifestyle which includes healthy eating habits, no smoking, avoiding excessive intake of alcohol and doing exercise.

There will be increased demand on your heart during pregnancy. You should visit your obstetrician and cardiologist early, at about six to seven weeks of pregnancy. They will plan your check-ups and scans depending on your heart condition(s). Your cardiologist will ask regarding any shortness of breath, irregular heartbeat and your exercise tolerance (when climbing the stairs or walking at a normal pace). Your blood pressure and heartbeat will be measured and your cardiologist will listen to your heart and lungs.

Natural birth or vaginal delivery is safe for the majority of women with congenital heart disease. It is important to limit the demand on the heart and good pain relied may be necessary. It is essential to discuss with your obstetrician the various aspects of delivery including the planning and timing of delivery, and the methods of pain relief. For some women, antibiotic prophylaxis is recommended before labour starts to prevent endocarditis.

Women with congenital heart disease may need to stay in hospital slightly longer after delivery to allow the heart to normalise to pre-pregnancy levels.

Diagnosis normally starts with a physical examination by a doctor, assessing your medical history and routine tests. Other tests recommended may include:

In Singapore, it is estimated that there are 12,000 adults with congenital heart disease and this number is expected to increase by around 300 annually. When patients with congenital heart disease enter adulthood, they require regular monitoring and further surgical intervention at times. In addition to the clinical issues, these patients may also face specific social, psychological and behavioural problems throughout their lives.

With this in mind, the Adult Congenital Heart Disease (ACHD) clinic at the National Heart Centre Singapore is set up to provide one-stop multi-disciplinary services to our ACHD patients so that they receive reliable diagnoses and personalized treatment plans.