by RAHIMI YUNUS

THE National Heart Institute (IJN) offers comprehensive care for pregnant mothers with heart disease to the forefront of its health service excellence.

The region’s leading centre for cardiovascular and thoracic care provides complete preconception counselling, antenatal and postpartum care for pregnant women with cardiovascular disease. 

The heart specialist centre, via the IJN Foundation, has teamed up with the Maternal Fetal Medicine Unit of Kuala Lumpur Hospital in the “Planned Pregnancy, Safer Outcome” campaign to help women with heart diseases have a safe pregnancy.

“Often, there is a delay in diagnosis or referral. Occasionally, the treatment is inadequate or sub-optimal and this may be due to an unplanned pregnancy,” said IJN senior consultant paediatric and adult congenital cardiologist Dr Geetha Kandavello (picture). 

Based on the Malaysian Confidential Enquiry into Maternal Deaths data, up to 50% of indirect maternal deaths in Malaysia between 2009 and 2014 were mainly due to heart disease during pregnancy.

The statistics also showed that one-third of mothers who died had known heart disease prior pregnancy.

“Heart disease may be diagnosed in some women for the first time during pregnancy. They may be coping well in the early stages of pregnancy but start to develop symptoms and complications as the pregnancy advances, increasing the risks to both mother and baby,” Dr Geetha said. 

The modified World Health Organisation (mWHO) cardiovascular risk stratification, which is endorsed by the Malaysian Clinical Practice Guidelines on Heart Disease in Pregnancy, has classified heart disease in pregnancy into four risk groups.

The outcome of the pregnancy is good if one falls into mWHO cardiovascular Risk One or Two. 

For pregnant patients in mWHO cardiovascular Risk Four, the risk for maternal death could go up to 30% or more. As such, pregnancy is not recommended.

Dr Geetha said most patients fall into mWHO Risk Three, which has maternal mortality of between 5% and 15% and a higher risk of complications to both mother and baby.

Fetal loss can be between 15 and 30% in some heart diseases.

IJN’s Cardiac Obstetric Combined Clinic registry showed that up to 70% of women in pregnancy with heart disease had no preconception counselling.

IJN provides early intervention to women with or at risk of heart disease with preconception counselling.

Dr Geetha said preconception counselling should be introduced during puberty and re-emphasised again when they are young adults, prior marriage and at least three to six months before pregnancy.

Such a counselling should involve the patient, partners and families, she added.

Other problems of advanced maternal age and comorbidities – including hypertension, diabetes, high cholesterol and obesity – also predispose women in the childbearing age to early-onset coronary artery disease.

“These women should have a cardiac assessment before embarking on a pregnancy,” Dr Geetha said.

She added that it is important to get a comprehensive medical assessment, review important past medical and obstetric issues, as well as medications as some medicines can be unsafe for the baby.

At the IJN-Maternity Hospital Kuala Lumpur (MHKL) cardiac obstetric combine clinic (IJN-MHKL COCC), contraceptive advice is provided to women with heart disease who are in the childbearing age group to enable them to plan their pregnancies.

It also has religious counsellors to help resolve conflict with regards to contraception, while the advice of geneticists, neonatologists and cardiothoracic surgeons are sought when indicated.

The clinic, which started to provide combined cardiology and obstetric services to women with heart disease since 2008, has expanded its service to include caesarian sections at IJN for high-risk patients who need close intensive care monitoring.

“We hope that our resources and expertise can help support hospitals and health care personnel throughout Malaysia.”

“Our mantra is ‘planned pregnancy for safer outcomes’ and we continue to endeavour towards making every pregnancy safe, especially in mothers with heart diseases,” Dr Geetha added.