Successful pregnancy possible even with heart defects

admin   •   January 19, 2017   •   4257

A pregnant woman stands on a scale before receiving a prenatal exam at the Maternity Outreach Mobile in Phoenix, Arizona October 8, 2009. REUTERS/JOSHUA LOTT

(Reuters Health) – Women who are born with high-risk heart defects can have successful pregnancies if they get the right medical support, according to new U.S. guidelines.

The guidelines are the first from the American Heart Association to offer a road map to women with congenital heart defects who have long been told to avoid pregnancy altogether, said Mary Canobbio, a researcher at the University of California, Los Angeles and chair of the committee that drafted the advice.

“Historically the tendency has been to advise these women to avoid pregnancy because the defect and surgeries done to keep these women alive are complex and the long term survival is difficult to predict – so concern has been that the ‘added burden’ of pregnancy could potentially cause more problems and decrease their own long term survival,” Canobbio said by email.

Congenital heart defects such as defective vessels, leaky valves or holes in the heart muscle are among the most common types of birth defects. These structural problems can cause symptoms like abnormal heart rhythm and breathing difficulties and may require surgery or a heart transplant.

While most girls born today with congenital heart disease will reach childbearing age, pregnancy carries a risk of complications for both these mothers and their babies.

One concern is that women’s blood volume increases by 50 percent during pregnancy to help support her growing baby. That means the mother’s heart must be able to handle the additional burden, Canobbio said.

Hormonal changes during pregnancy can also increase the risk of irregular heart rhythm and blood clotting. In healthy women these changes aren’t usually a problem, but in women with structural heart damage this can increase their risk of stroke, Canobbio added.

Pre-pregnancy counseling is essential for women with complex congenital heart defects so that they have a clear understanding of how their heart abnormalities could affect both their own health and the health of their child during a pregnancy, the new guidelines advise.

For some structural heart problems, and women with a family history of these problems dating back several generations, genetic screening before conception can help estimate the odds that women may pass heart defects on to their children.

Once pregnant, a delivery plan is also essential, so the medical team can anticipate problems that could happen during and following delivery and be prepared.

Ideally, women should deliver their babies at medical centers that have a cardiologist experienced in managing complex congenital heart disease, obstetricians trained in high-risk maternal-fetal medicine, cardiac anesthesia and a cardiac surgical team.

After delivery, women need monitoring for up to six months because the effects of pregnancy can linger that long, the guidelines also note.

The scientific statement, published in Circulation, will likely set a new standard of prenatal, delivery and postpartum care for women with congenital heart defects because this marks the first time a leading U.S. cardiology group has weighed in, said Dr. Wayne Franklin, medical director of the adult congenital heart disease program at Texas Children’s Hospital in Houston.

“The take-home message here is that women should talk to their cardiologist, and also obtain preconception counseling with a maternal-fetal-medicine specialist, if they have a heart problem but are considering pregnancy,” Franklin, a researcher in obstetrics and cardiology who wasn’t involved in the guidelines, said by email.

That’s because normal changes in blood volume, heart rate and blood pressure that happen in every pregnancy can adversely affect women with congenital heart disease, Franklin said.

And, mothers with congenital heart disease have an 8- to 10-fold increase in the chance of their baby having a congenital heart defect, Franklin added. With close monitoring, many problems in developing infants can be detected before infants are born.

“We now know that with close collaboration with a multi-disciplinary team, we can achieve excellent outcomes for both the mother and baby,” Franklin said.

SOURCE: Circulation, online January 10, 2017.

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DOH, tiniyak na ligtas pa ring manganak sa ospital sa gitna ng COVID-19 crisis

Robie de Guzman   •   April 10, 2020

MANILA, Philippines – Pinawi ng Department of Health (DOH) ang pangamba ng mga buntis hinggil sa kaligtasan ng panganganak sa mga ospital sa gitna ng krisis sa novel coronavirus disease (COVID-19) sa bansa.

Sa isang Facebook post, tiniyak ng DOH na ligtas pa ring manganak sa mga ospital dahil may sinusunod na istriktong panuntunan ang health facilities upang masegurong ligtas sa naturang sakit ang mga buntis at isisilang nilang sanggol.

“Huwag tayong mangamba na manganak sa ospital. Ang ating mga ospital ay may mahigpit na infection prevention and control measures. Hindi nito pababayaan ang kalusugan niyo at ni baby,” saad ng ahensiya sa isang pahayag.

“Ginagawa nila ang lahat ng kanilang makakaya upang makapagbigay ng dekalidad na birthing services habang patuloy ang paglaban ng ating bansa kontra sa COVID-19,” dagdag pa nito.

Payo rin ng DOH sa mga malapit nang manganak na makipag-ugnayan sa mga opisyal ng kanilang barangay para maihatid sa pagamutan lalo na at suspindido ang public transport habang umiiral ang enhanced community quarantine sa buong Luzon.

“Kung walang masakyan papuntang paanakan, ipagbigay-alam ito sa inyong barangay upang mapaghandaan bago pa man manganak,” sinabi ng ahensya.

Sa gitna ng COVID-19 crisis, sinabi ng DOH na pinakaligtas pa ring manganak sa isang health facility na nagbibigay ng birthing services gaya ng maternity at newborn care.

Maaari ding manganak sa mga sumusunod na pasilidad na lisensiyado ng DOH at accredited ng Philhealth:

  • Birthing facility ng Helath Center o Municipal/Rural Health Units
  • Mga pribadong lying-in clinics na mayroong midwife, nurse at doctor
  • Mga infirmary

“Kung pipiliing manganak sa panibagong health facility na iba sa inyong napagplanuhan, siguraduhing makipag-ugnyan sa inyong health care provider pang siya ay makapagbigay ng tamang referral o endorsement,” ayon sa DOH.

Kapag malapit nang manganak, mas mainam na rebyuhin ang birth plan (mother-baby book o pregnancy record mula sa inyong healthcare provider), at hangga’t maaari ay ituloy ang prenatal check-ups o kaya ay makipag-usap sa inyong healthcare provider sa pamamagitan ng tawag, text message o email habang may community quarantine.

Dapat ring ihanda ang maternity bag at newborn bag, at isilid rito ang inyong mother-baby book at PhilHealth card.

Ngayong may kumakalat na virus, pinapayuhan ng DOH ang mga buntis na ipagpatuloy ang pag-inom ng supplements na sagana sa iron at folic acid, kumain ng masusustansiyang pagkain at panatilihin ang kalinisan ng katawan, umiwas sa mga pagkaing maalat at mamantika, at ugaliing maghugas ng kamat gamit ang sabit at tubig bago at pagkatapos hawakan at pasusuhin ang inyong sanggol.

High blood pressure in pregnancy may not disappear afterward

UNTV News   •   February 7, 2018

FILE PHOTO: A pregnant woman is seen in a handout photo. REUTERS/Newscom

(Reuters Health) – Women who develop high blood pressure during pregnancy may have the condition reappear within a year of delivery, and many of them may go undiagnosed because the problem only surfaces at night, a new study suggests.

Preeclampsia, or high blood pressure that develops during pregnancy, is common. In severe cases, it can become fatal or result in serious complications for babies like organ damage or stunted growth. While the condition has also long been linked to an increased risk of women developing high blood pressure later in life, the current study offers fresh insight into why it might go undetected.

For the study, researchers focused on 200 women with severe preeclampsia that resolved after the women gave birth. In 24-hour home blood pressure testing done one year after these women gave birth, 42 percent of them had developed high blood pressure.

But only 24 percent of these cases would have been caught by a quick blood pressure check at the doctor’s office, researchers report in Hypertension. That’s because in many instances, women had high blood pressure at night.

“Our findings suggest that women who have high blood pressure during pregnancy should continue to monitor their blood pressure long after they’ve delivered their babies,” said lead study author Dr. Laura Benschop of Erasmus Medical Center in the Netherlands.

“Women with previous severe preeclampsia should also receive 24-hour blood pressure monitoring one year after pregnancy to diagnose any type of hypertension that cannot be diagnosed with a single office blood pressure measurement,” Benschop said by email.

Most of the women were around 32 years old when pregnant, and they were typically first-time mothers. On average, they were diagnosed with preeclampsia at around 30 weeks’ gestation, during the third trimester.

By one year after delivery, roughly one in five of the women had already been diagnosed with hypertension and been given medication to treat it.

During the home-based tests, 43 percent of the women had high blood pressure at night and 32 percent had it during the day.

Beyond its small size, another limitation of the study is that it included mostly white and highly educated women, and results from this group may not represent what would happen for other patients, the authors note.

“The study itself is not sufficient to directly recommend specialist screening for all women with previous preeclampsia,” Dr. Simon Timpka, a researcher at Lund University and Skane University Hospital in Malmo, Sweden, who wasn’t involved in the study, said by email.

However, the results do suggest women should get annual blood pressure checks from their general practitioners, advised Heather Boyd, a researcher at the Statens Serum Institut in Copenhagen, Denmark.

“We might need to think about expanding annual blood pressure checks to include home monitoring for a 24-hour period, at least for women with a history of severe preeclampsia,” Boyd, who wasn’t involved in the study, said by email.

Beyond getting their blood pressure checked, women can also take steps to prevent it from becoming elevated, noted Dr. Nieca Goldberg, medical director of the Joan H. Tisch Center for Women’s Health at New York University Langone Medical Center.

“They should also follow a healthy diet . . . and lower their salt intake,” Goldberg, who wasn’t involved in the study, said by email. “Exercise and stress reduction are also good ways to keep your blood pressure in the healthy range.”

SOURCE: Hypertension, online February 5, 2018.

Mom’s age at birth linked to daughter’s later childlessness

UNTV News   •   January 11, 2018

Pregnant women attend a yoga class in Madrid March 17, 2009. REUTERS/Susana Vera

(Reuters Health) — Moms who have children later in life are more likely to have daughters who don’t have kids, according to a new study.

Compared with women born to 20- to 24-year-old mothers, daughters born to mothers in their mid-20s or 30s were more likely to be childless, the study authors report in the journal Human Reproduction.

“In many countries, couples are having children later and later, and there haven’t been many studies of future reproduction,” said study author Dr. Olga Basso of McGill University in Montreal, Canada.

Basso and colleagues analyzed data from the U.S.-based Sister Study on more than 43,000 women born between 1930 and 1964.

Overall, about 7,600 women – or nearly 18 percent – hadn’t given birth. The researchers found that as maternal age at delivery went up, so did the odds that daughters would be childless.

Compared with study participants born to 20- to 24-year-old mothers, for instance, the odds of childlessness were 21 percent higher for participants born to mothers ages 25-29, 30 percent higher for women born to mothers ages 30 to 34, and 40 percent higher for women born to mothers who were 35 or older.

Basso and colleagues want to know why. They’re interested in future studies about changes in biology, behavior and socioeconomic status and how those could affect birth and childlessness.

“It could be that women who have children at an older age have daughters instilled with different behaviors,” Basso said. “They may have different ambitions and different plans.”

“I was concerned when I saw these findings because I really think women should have children when they’re ready as a matter of choice,” she told Reuters Health by phone. “I don’t want people to believe, as a result of this, that they need to have children when they’re 25.”

Additional studies are looking at the effect of father’s age on childlessness and the historical trends of childbirth.

“We’ve seen an increase in age at first birth, or when women have their first child, but the age hasn’t changed much for last birth,” said Ruben Arslan of the Max Planck Institute for Human Development in Berlin, Germany. Arslan, who wasn’t involved with this study, researches delayed childbearing.

“In past decades, women had children for longer and had more children,” Arslan told Reuters Health by phone. “What we’re seeing is not unprecedented, and it’s not a reason to get worried about childbearing now.”

The main limitation of the study is that researchers didn’t know whether women’s childlessness was by choice and intentional.

“It’s important to think about the consequences and social structures that would give women more choices,” said Dr. Sarah Hayford of Ohio State University in Columbus. Hayford, who wasn’t involved with this study, researches childlessness trends in the U.S.

“The question of childlessness is often framed as a negative outcome, without asking about whether it was voluntary or not,” Hayford told Reuters Health by phone. “But studying the voluntary nature is a complicated task, especially over a broad population, when it’s such a personal decision.”

The cultural context is key, too. A stronger family orientation, religiosity, and other cultural values may contribute to earlier childbearing, which may be passed down to children, said Dr. Martin Kolk of Stockholm University in Sweden, who studies intergenerational patterns of childbearing but wasn’t involved with this study.

“Fertility decisions are often shared between daughters (and sons) and mothers (and fathers),” Kolk told Reuters Health by email. “We’re seeing additional evidence that there is a strong familial and cultural factor affecting childbearing.”

SOURCE: Human Reproduction, online December 4, 2017.


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