Congenital Heart Defects: What precautions should young parents take to protect their unborn child from CHD?

By Dr. Pankaj Sugaonkar,

Heart disease is the No 1 killer in India, but did you know that many heart or cardiac conditions can exist from birth? These conditions come under the umbrella term of congenital heart defects (CHD). Congenital simply means ‘present since birth.’ Nearly 30% of birth defects are due to CHDs and they occur in 8-12 out of 1000 live births. In India, annually, nearly 2,40,000 are born with CHD, placing a considerable strain on the parents and the children themselves. Tremendous advances in paediatric cardiac care have improved the survival of many babies with CHD. However, 10% of all infant deaths in India are due to CHD.

What is CHD?

The baby’s heart is divided into four chambers. The two smaller upper chambers are called atria and are divided by a thin wall called the atrial septum. The two lower larger ones are called ventricles and are separated by the ventricular septum. Blood flow in the heart takes place in one direction and is controlled by gates known as valves. Any problem in the development of the heart in the mother’s womb can result in a CHD. Depending upon whether the defect affects the oxygen levels in the baby’s blood, CHDs are of two main types—acyanotic (60-70%; normal babies) and cyanotic (30-40%; blue babies). In acyanotic CHDs there is sufficient oxygen in the baby’s blood but it flows abnormally. Some examples include ventricular or atrial septal defects (hole in the atrial or ventricular septum) or patent ductus arteriosus (PDA; occurring in premature babies). In PDA, there is an abnormal connection between the major blood vessels of the heart—aorta and pulmonary artery. Cyanotic CHDs are more severe conditions where the baby’s body gains a bluish tinge due to insufficient oxygen supply. One such condition is the transposition of the great vessels in the heart where the pulmonary artery and aorta get switched. 

What are the precautions that parents can take to protect their unborn child’s heart?

Some common precautions taken during pregnancy that can help reduce the chances of CHD include

• Appropriate age and weight of the mother when she conceives
• Adequate folic acid supplementation
• Avoidance of smoking and drinking (even passive smoking can be dangerous)
• Maintenance of excellent blood pressure in ladies who are diabetic or have gestational diabetes
• Avoidance of medicines that can interfere with the baby’s development or coming in contact with radiation, pesticides or other harmful chemicals
• Ensuring vaccinations are up-to-date (since viral infections like rubella or German measles can cause CHD)

On the other hand, certain genetic factors such as consanguineous marriages can also increase the risk of CHD. Moreover, in the case of parents who already have a child with CHD, the chances of having a second child with CHD are 3%. Such parents must mentally prepare themselves for this higher likelihood. Overall, a planned rather than an accidental pregnancy can help the doctor and the parents anticipate things more clearly. 

Can CHD be detected during pregnancy?

Yes, fetal echocardiography at 18-20 weeks (5^th month) of pregnancy can help detect most CHDs in the womb itself. This can help the parents and the medical team prepare themselves for the baby’s special needs after birth. 

What are the symptoms of CHD?

The appearance of symptoms depends on the severity of the CHD. Symptoms of acyanotic CHD in newborns include repeated respiratory infections, lack of weight gain and poor feeding. Less severe forms may present in later childhood as difficulty in breathing, tiredness upon exertion and fainting spells. The main symptom seen after birth in babies with cyanotic CHD is bluish discoloration of the baby’s nails, lips, tongue and toes along with lack of increase in weight and height. 

How have technological improvements in treatment decreased infant death due to CHD?

Early diagnosis is the key to successful treatment. Over the past few decades, treatment options for babies with CHD have improved tremendously. Depending on the severity of CHD, options include medicines, minimally invasive procedures and surgery. For cyanotic CHD, surgery is the main option but technological improvements have increased the chances of survival tremendously. In acyanotic CHD, survival rates are nearly 100% since minimally invasive interventions are now available. For example, an umbrella-like device can be inserted through a tiny incision in the leg to seal the atrial/ventricular septal defect of the baby. Even in the case of PDA, a small button-like device is available to seal the hole. Most importantly, after such procedures, patients recover in 2-3 days and show significant improvement. However, follow-up appointments for all procedures are very important.

Enormous enhancements in technology have made early detection and successful treatment of CHD a reality. Irrespective of when the CHD is detected, during pregnancy or after the birth of the baby, parents can rest assured that cutting-edge treatment is available. So follow the precautions and your doctor’s instructions and do not hesitate to reach out for timely help.

(The author is Consultant Paediatric Interventional Cardiologist, Little Heart, Pune. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)