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Congenital Heart Disease And Heart Defects
A congenital heart defect (CHD) is the most common form of congenital heart disease.
A CHD is a difference in the structure of the heart or a main artery. A person is born with it, and in the United States, nearly 1% of babies are born with a CHD each year.
This type of abnormality can obstruct blood flow in the heart or nearby vessels, or it may cause blood to flow through the heart irregularly.
In the past, it was common for CHDs to cause health issues that proved fatal, but medical and technological advances mean that most people with these differences survive into adulthood. Each person's outlook depends on the severity of their CHD.
Children who undergo treatment for CHDs should continue to have follow-up monitoring throughout adulthood. Those with complex health needs might require lifelong specialized care.
Doctors classify CHDs depending on the part of the heart most affected. The most common type is a ventricular septal defect. This involves the wall between the heart's two ventricles never fully developing in utero, leaving a gap.
There are also different types of congenital heart disease. It may be "cyanotic," in which case an abnormality causes low blood oxygen levels.
Infants with cyanotic congenital heart disease experience breathlessness, fainting, and fatigue, and they may have bluish toes, fingers, and lips.
Alternately, the disease can be "acyanotic." In this case, there is enough oxygen in the blood, but the heart does not pump the blood around the body effectively.
Certain types of CHD can lead to blood pressure that is higher than usual. This is because the heart must work harder to pump blood, which can weaken it.
Specifically, there may be high blood pressure in the arteries of the lungs, an issue called pulmonary hypertension, which can lead to breathlessness, fatigue, dizziness, and fainting.
Cyanotic heart disease may cause:
Acyanotic heart disease may cause:
There may be no symptoms soon after birth — these may only arise as a child grows older, and they may need treatment.
A CHD usually develops during the early stages of development.
There is a higher risk if the pregnant person:
Genetics may also play a role. At least 15% of people with a CHD also have a genetic disorder. Some genetic disorders may increase the risk of having a CHD.
Tests can show heart problems such as CHDs before and after birth.
Before birthRoutine ultrasound scans during pregnancy can give information about the structure of the fetal heart.
If the scan indicates a problem, fetal echocardiography can help show a CHD. This is like an ultrasound scan, but it can collect more detailed information about the heart's chambers.
After birthA newborn with cyanotic congenital heart disease tends to have recognizable symptoms, but those of acyanotic congenital heart disease may not appear until the child is 3 years old or older.
Seek medical advice if a child of any age has any symptoms of congenital heart disease, including breathlessness or difficulty feeding.
A physician typically assesses heart activity using an electrocardiogram, an echocardiogram, or both.
Echocardiography is an imaging technique that usessound waves to create a moving image of the heart. It shows the heart's size and shape and how well the chambers and valves are working.
This technique can show areas of low blood flow and any part of the muscle that is not contracting effectively. It can also show whether the heart muscle has sustained any damage due to low blood flow.
An electrocardiogram, or ECG, provides information about the heart's electrical activity, including the rhythms and the size of the chambers.
An X-ray can show any enlargement of the heart and whether there is too much blood in the lungs.
Pulse oximetry, meanwhile, measures the levels of oxygen in the blood of the arteries through a sensor placed on the fingertip, ear, or toe.
Children and adults can have these tests.
Adults may also need to do an exercise stress test. This involves exercising on a treadmill while a health professional measures blood pressure and heart activity.
According to the Centers for Disease Control and Prevention (CDC), around 1 in 4 infants with a CHD have an abnormality that is critical and requires surgery during their first year of life.
In other cases, the symptoms improve without treatment or the abnormality is small and does not need treatment. The doctor may recommend watchful waiting to determine whether medication or surgery is necessary.
A person with a CHD may need treatment, such as medication to lower blood pressure, at any age.
SurgeryA surgeon may correct the CHD through a catheter or an open heart procedure.
The specific approach depends on the CHD. Options include:
Specifically, the surgeon may use a balloon valvuloplasty to repair a valve. This involves passing a small balloon through a catheter and inflating it to widen the valve. A stent or metal coil can then stop the valve from narrowing again.
In adulthoodAfter surgery, the heart generally works as it should, but some people develop related problems with age.
And if there is scar tissue on the heart, as a result of the surgery, this can increase the risk of problems.
The person may experience:
Also, mild symptoms of a CHD that do not warrant surgery during childhood may worsen over time and require treatment in adulthood.
CHDs can lead to complications, such as:
Developmental problemsA child with a CHD may start walking and talking later than their peers, and they may have learning difficulties. They may also be smaller than others of the same age.
ArrhythmiasAn irregular heartbeat, or arrhythmia, can be a complication of CHD. The name for a fast heartbeat is tachycardia, and a slow one is called bradycardia.
If the heart cannot pump blood around the body effectively, heart failure can result.
This can affect either or both sides of the heart, and the symptoms vary accordingly. Heart failure can be fatal and requires immediate attention.
Pulmonary hypertensionUncontrolled high blood pressure in the arteries of the lungs, known as pulmonary hypertension, can lead to irreversible lung damage.
EndocarditisInflammation of the lining, valves, or muscles of the heart — called endocarditis — can spread from the skin, gums, or elsewhere in the body. Having a CHD increases the risk of this problem.
A strokeIf there is an obstruction in the flow of blood to a part of the brain, a stroke can result.
Blood carries oxygen and glucose to the brain, and without this, brain cells die. The effects of a stroke can include problems with speech, movement, and memory.
To reduce the risk of complications, the CDC recommend:
It is also important to recognize the warning signs of a heart attack, including:
If anyone experiences these symptoms, it is crucial to call 911 immediately or otherwise request emergency medical care.
Living with CHD may cause anxiety and depression. A doctor should be able to provide the details of local support groups.
In the past, CHDs were usually fatal, but medical advances over the last few decades have significantly increased survival rates.
The outlook depends on the:
Doctors now expect that around 96% of people who receive a CHD diagnosis and hospital treatment survive. Meanwhile, research into further advances continues.
In the future, treatment might involve using bioengineered tissues rather than prostheses and fixing any problems in the developing heart before birth.
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What Is Gestational Diabetes, And Why Does It Develop?
Gestational diabetes refers to high blood sugar during pregnancy due to the body developing a resistance to insulin. It is important to receive treatment for gestational diabetes, and blood sugar levels may return to normal after pregnancy.
Insulin is the hormone that controls blood sugar levels. Without treatment, gestational diabetes may harm the person and the baby. After the baby is born, gestational diabetes usually resolves, and blood sugar levels return to normal.
This article discusses what gestational diabetes is, its causes, and how to treat it.
When blood sugar, or blood glucose, levels rise too high during pregnancy, the medical name for this is gestational diabetes. The hormonal changes that can cause it usually begin around the 20–24th week of pregnancy, in the second trimester.
A doctor usually tests for the condition between the 24th and 28th week of pregnancy.
Excessive levels of glucose in the bloodstream could cause complications for the pregnant person and their unborn baby. This is why it is important that a doctor diagnoses gestational diabetes promptly to ensure that blood glucose levels are stable.
Around 2–14% of pregnant women in the United States develop gestational diabetes.
Blood sugar levels usually return to normal after the baby is born, though about 50% of women who experience gestational diabetes may develop type 2 diabetes in the future.
Insulin resistance can lead to gestational diabetes. Though the body still produces insulin, the hormone is no longer effective at reducing blood sugar levels.
Hormones released from the placenta interfere with how well insulin can store glucose in fat and muscle cells. As a result, levels of glucose in the blood rise.
During pregnancy, all women experience some insulin resistance. Usually, the body produces additional insulin to compensate.
However, when a person has gestational diabetes, the body typically does not produce enough insulin to overcome insulin resistance.
Gestational diabetes usually does not cause symptoms. But it may cause increased thirst, and a person may notice that they need to urinate more than usual.
Anyone who experiences concerning symptoms during pregnancy should contact a healthcare professional, no matter how subtle the symptoms are. People's experiences of pregnancy vary. The changes could be a regular part of the pregnancy's progression, but if a person is worried, it is important to receive medical advice.
The goal of treatment is to manage blood glucose levels, usually through lifestyle changes.
Dietary recommendationsThe American Diabetes Association recommends a healthy diet for managing blood glucose levels.
Pregnant women, in general, should aim for:
After receiving a gestational diabetes diagnosis, a person should limit their intake of saturated fats and avoid trans fats altogether.
A healthy diet for someone with diabetes includes:
It also involves avoiding sweets and other foods high in added sugar.
A doctor can describe the types of fish that pregnant people should avoid due to high levels of mercury. The Food and Drug Administration (FDA) have list to help guide the discussion.
The Centers for Disease Control and Prevention (CDC) recommend tracking carbohydrate levels and using the "plate method" for meal planning. This involves nonstarchy vegetables taking up half of every plate of food.
Before changing the diet, however, it is a good idea to speak with a doctor, registered dietician, or nutritionist about specific amounts of carbs, proteins, and fats to consume.
Learn more about healthy diets for people with gestational diabetes.
Physical activityGetting regular exercise is another important component of managing blood glucose levels. However, it is especially important for pregnant people to speak with a healthcare professional before doing more physical activity.
MedicationWhen lifestyle changes are not working, a healthcare professional may prescribe medication to keep blood glucose levels under control. These medications may include insulin.
According to the American Diabetes Association, doctors recommend monitoring blood glucose levels throughout pregnancy. If a person is taking insulin, they may need to monitor more frequently to ensure that the dosage is correct.
Healthy glucose levels for women with gestational diabetes are under:
Doctors check for gestational diabetes between the 24th and 28th weeks of pregnancy using blood tests. These may involve a one- or two-step glucose tolerance test.
The one-step glucose tolerance test requires fasting overnight. A healthcare professional draws blood the next day to get a baseline reading. The person then consumes a drink containing 75 g of glucose. An hour later, a healthcare professional draws blood. They do this again after another hour has passed.
The two-step test does not require fasting. Instead, a person consumes a drink that contains 50 g of glucose, and a healthcare professional draws blood 1 hour later.
If the reading is abnormal, the person may need to do a 3-hour oral glucose tolerance test. This requires fasting. The person then consumes 100 g of glucose, and a healthcare professional draws their blood at 1 hour, 2 hours, and 3 hours afterward.
People with obesity or larger bodies are at risk for gestational diabetes. A person is also at risk if they gain too much weight during pregnancy.
Some other risk factors for gestational diabetes include:
Gestational diabetes affects up to 14% of all pregnancies in the U.S., and about 60% of women with the condition develop another form of diabetes within 10 years after delivery.
While rates of occurrence and outcomes can be disproportionate, the risk of gestational diabetes increases with an increase in body mass index (BMI) across racial and ethnic groups. However, studies have found that even in cases of low BMI among Hispanic and Asian people, there is an increased risk.
A 2019 study compared the prevalence rate of gestational diabetes in Asian women to women of other ethnic backgrounds in a group of 5,562 women who had participated in a previous study conducted in Los Angeles. The study included a secondary component and evaluated whether acculturation had an impact on the outcome.
None of the women involved had type 1 or type 2 diabetes before their pregnancies, and the study adjusted for the known risk factors of the condition. The researchers found the following prevalence rates:
A 2016 study found that the prevalence rate of gestational diabetes among American Indian and Alaska Native people was 8.9%.
However, most studies that discuss gestational diabetes and use racial and ethnic differences for clarity are limited. Further research that considers environmental, behavioral, genetic, and socioeconomic factors, as well as access to healthcare, is necessary.
Gestational diabetes does not typically cause congenital anomalies or abnormalities. This is because the condition develops in the second trimester.
Most of the possible complications are manageable. Still, congenital conditions are associated with poorly controlled blood sugar levels in people who have diabetes before they become pregnant.
Some examples of the complications of gestational diabetes include:
Gestational diabetes may also increase the risk of preeclampsia. This condition can develop from high blood pressure during pregnancy. It can be life threatening for the pregnant person and the unborn baby.
People who develop preeclampsia may require an early delivery, which could involve a cesarean delivery.
Having gestational diabetes may also increase the risk of developing type 2 diabetes in later life, so it is important to be aware of the symptoms of this disease.
Learn more about the symptoms of diabetes here.
People with larger bodies or obesity have an increased risk of gestational diabetes. A nutrient-dense diet and regular physical activity are important for maintaining a healthy weight during pregnancy.
However, a person should discuss any potential changes to their diet or physical activity levels with a doctor, especially while pregnant.
Learn more about preventing gestational diabetes here.
Gestational diabetes refers to high blood sugar levels during pregnancy. The condition usually causes no symptoms, but some people have increased thirst or urinate more often.
People with larger bodies or obesity have a higher risk of gestational diabetes and should be mindful of the symptoms while pregnant.
With appropriate treatment, gestational diabetes is manageable. If a person does not receive treatment or make necessary changes, it could lead to serious complications, such as preeclampsia.
In most people with gestational diabetes, blood sugar levels return to normal after the baby is born. Nevertheless, some people who have had gestational diabetes go on to develop type 2 diabetes, so being aware of the symptoms of this condition is important.
Pregnant people should receive prenatal care and attend all the recommended screenings, evaluations, and other appointments.
Reproductive Health Counseling Among Women With Congenital Heart Defects
Receipt of clinician counseling on reproductive health issues among women with congenital heart defects, by disability status, CH STRONG, 2016–2019. 1Standardized to the birth year, maternal race/ethnicity, site, and CHD severity of the CH STRONG- eligible female population. 2Adjusted for state of birth, age, CHD severity, race/ethnicity, type of health insurance. APR, adjusted prevalence ratio; CI, confidence interval; CH STRONG, Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG; CHD, congenital heart defects. Credit: Journal of Women's Health (2023). DOI: 10.1089/jwh.2022.0395 A new study shows that among women with congenital heart defects (CHD), reproductive counseling, concerns, and experiences differ by disability status. The study, which focused on contraceptive and pregnancy counseling, and pregnancy concerns and experiences, is published in the peer-reviewed Journal of Women's Health.
Sherry Farr, Ph.D., from the Centers for Disease Control and Prevention, and co-authors, based their findings on data from 778 women ages 19-38 years with CHD. The investigators reported that women with disabilities were 1.4 more likely than women without disabilities to have ever had a conversation with their provider about safe contraceptive methods, and 2.3 time more likely to have received advice to avoid pregnancy because of their CHD.
Approximately half a million adolescent and adult women are living with CHD in the U.S. Women with CHD are at increased risk of pregnancy complications and adverse outcomes, although most will have healthy pregnancies. Pregnancy is contraindicated only among a small subset. Among women with certain types of CHD, certain types of contraceptives are contraindicated.
In an accompanying Editorial titled "We Can Do Better—Reproductive Health Counseling for Women with Congenital Heart Disease and Disabilities," Natasha Wolfe, MD, from the University of Pittsburgh School of Medicine, states: "Looking closely at the numbers, 8% of women with CHD and no disabilities were told to avoid pregnancy, while 18% of women with CHD and at least 1 disability were told to avoid pregnancy. From a cardiac perspective, 18% of all women with CHD and disabilities seems like a high number to be told to avoid pregnancy altogether."
"This study shows us that we can need to do better to help women with CHD understand her unique pregnancy risk, know how to safely prevent unplanned pregnancy, and make an informed decision on the right time to pursue having a child of her own," says Dr. Wolfe.
More information: Sherry L. Farr et al, Reproductive Health Counseling and Concerns Among Women with Congenital Heart Defects With and Without Disabilities, Journal of Women's Health (2023). DOI: 10.1089/jwh.2022.0395
Natasha K. Wolfe, We Can Do Better: Reproductive Health Counseling for Women with Congenital Heart Disease and Disabilities, Journal of Women's Health (2023). DOI: 10.1089/jwh.2023.0042
Citation: Reproductive health counseling among women with congenital heart defects (2023, June 7) retrieved 19 June 2023 from https://medicalxpress.Com/news/2023-06-reproductive-health-women-congenital-heart.Html
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