There is no right time to learn that your baby has a heart defect. While great advances have been made in infant heart surgery, there’s no way to prepare for that kind of news. The prognosis, however, can be much better when a diagnosis is made early. The majority of babies with congenital heart defects (defects that develop before birth) get treated and go on to live normal lives.
When doctors detect heart defects in the womb, parents have time before their baby is born to understand and accept the situation. Doctors have the information they need to monitor the baby carefully and make plans for the most appropriate care before, at and after the birth. In some cases, mothers can be given medication to treat specific problems, including abnormalities in heart rhythm or function, before birth.
Advanced testing makes early diagnosis possible
We now have the technology to detect cardiac anomalies in fetuses as early as the second trimester. If we detect a thick nuchal translucency (a collection of fluid under the skin at the back of the baby’s neck) during our first trimester advanced, high-resolution ultrasound, this may indicate the baby is at risk. In that case, we will schedule fetal echocardiography during the second trimester. Magnetic resonance imaging (MRI) and other tools can also give us a detailed look at the baby’s heart.
Unfortunately, not all medical practitioners are aware of the availability of these services or consider their patients at risk. Less than half of all congenital heart defects are diagnosed before birth. Therefore, in April of 2014, the American Heart Association published updated guidelines on detecting, managing and treating congenital heart problems in utero in order to promote earlier intervention.
Who is at risk?
Congenital heart disease is not that common. Roughly 8 out of every 1,000 babies are born with a heart defect (less than one percent). The majority of congenital heart defects have no known cause. However, there are some situations that put women at increased risk of having a baby with such a defect. These include:
- Having a heart defect yourself
- Having a parent or sibling who was born with a heart defect
- Taking antiseizure medicine during the first trimester
- Taking lithium to treat depression
- Taking painkillers called nonsteroidal anti-inflammatory drugs (NSAIDS) in the third trimester
- Obesity
- Going into a pregnancy with diabetes
- Getting pregnant through IVF
- Having a baby with chromosomal abnormalities, such as Down Syndrome
What can you do?
If you’re considered at higher risk, first trimester testing [link to http://hrpregnancy.wpengine.com/our-care/first-trimester-testing/], when done by a maternal fetal medicine specialist, can detect heart abnormalities as early as 11 to 13 weeks.
If tests indicate a potential problem, the specialist may recommend fetal echocardiography. The High Risk Pregnancy Center is one of the few practices in the Western United States performing first trimester echocardiography. For the mother, this pain-free test is similar to an ultrasound.
If congenital heart disease is detected, your maternal fetal medicine specialist can work with your obstetrician and a pediatric cardiologist to plan for the most effective care. You should ask for the support of counselors to help you deal with whatever grief you may experience, get the education you need, and prepare you for whatever treatment is required after birth.
Depending on the complexity of the defect, your baby may simply need monitoring after birth for the first year or two of its life. More complex heart defects may require immediate treatment at birth or within the first year. Treatments can range from medication to surgery. Many surgeries that once were done as open-heart procedures are now performed using a tiny catheter through a vein.
It may be helpful to know that over a million adults are living in the United States with congenital defects. Almost all children now born with heart defects survive to adulthood and live active, healthy lives.
Leading the way in maternal fetal medicine
The High Risk Pregnancy Center is at the forefront of detection and management of fetal abnormalities and was among the earliest 10 practices in the country accredited in fetal echocardiography. Our maternal fetal medicine specialists and nurse practitioners are happy to talk with you about any questions you might have about your pregnancy and congenital heart disease.