Search

Background Although breastfeeding can cause an increase in the maternal cardiac load, little is known about how it affects the postpartum clinical course among women with congenital heart disease (CHD). The aim of this study was to evaluate whether breastfeeding affects the incidence of postpartum cardiovascular events and the levels of brain natriuretic peptide (BNP) among mothers with CHD. Methods A review of 153 pregnancies in 153 women with CHD was conducted. Postpartum outcomes, including late postpartum cardiovascular events and BNP levels, were analysed by breastfeeding status. Results Ninety-three were primarily breastfeeding (the breastfed-group) and 60 were primarily formula feeding (the formula-group). The formula-group had a significantly higher rate of women with severe conditions, defined as class II-III and III of the modified World Health Organization (WHO) classification of maternal cardiovascular risk, than the breastfed-group (p = 0.03). Late postpartum cardiovascular events occurred in 11 women and not feeding status, but medication use, was the only correlated factor for the events in multivariate analysis. The values of BNP in the third trimester (29.2 pg/mL vs 32.8 pg/mL; p = 0.15) and at one-month postpartum (23.7 pg/mL vs 24.9 pg/mL; p = 0.26) were not statistically different between the breastfed-group and the formula-group. Even when limited to women with the modified WHO class III disease, BNP values were not significantly different between the two groups. Conclusions Among postpartum women with CHD, the cardiovascular event rates and BNP values may not be affected by feeding status, but mostly by disease severity.

Recent advances in cancer therapies have enabled many women diagnosed with malignancies during childhood and adolescence to survive longer and therefore to reach an age where they wish to conceive. When providing cancer treatment such as anticancer drugs and radiotherapy, attention is often paid to preserving future fertility, but little is known about maternal pregnancy risks, and in particular cardiovascular complications. Recent studies have shown that cardiovascular diseases such as cardiomyopathy, heart failure, and arrhythmias often occur during and soon after anticancer therapy. This has led to the emergence of the specialized field of "onco-cardiology" or "cardio-oncology," in which oncologists and cardiologists collaborate, as well as the publication of multiple clinical practice guidelines. The interdisciplinary onco-cardiology team plays an important role in further improving the prognosis of cancer survivors. The current recommendation for women after anticancer therapy who wish to conceive is to undergo cardiovascular screening, regardless of whether there is a history of cardiovascular complications or not, in order to provide preconception counseling. Pregnancies in cancer-survivors, who experience cardiovascular complications, should be managed perinatally by a multidisciplinary team including obstetricians and cardiologists. Absence of cardiovascular disease on screening does not preclude the possibility that new cardiac dysfunction may occur during the perinatal period, especially in women with a history of high-dose anthracycline drug administration and/or radiation therapy. In such high-risk cases, follow-up of cardiac function throughout the perinatal period is required.

Circulatory dynamics markedly change throughout pregnancy and delivery. While many women with heart disease deliver safely, some diseases and pathological conditions are life-threatening and high risks for both mother and fetus. Thus, preconception counseling is important for safety of women with cardiovascular disease, and it is preferable to start counseling from the teenage years among women with congenital heart disease. The specialized multidisciplinary medical team, including obstetrics, adult and pediatric cardiology, anesthesiology, cardiac surgery, genetic clinic, and neonatology, is essential for high-risk pregnancy, and involvement of the team is also important in preconception counseling. Teenage years are the same timing of transitional care. As a prerequisite of counseling, it is necessary to identify whether the patient sufficiently understands their own disease and symptoms, and it is preferable to begin with an explanation of these issues when understanding is insufficient. It is important to offer the safe contraception for women with heart disease, who do not want to get pregnant, since some contraception increase the risk of thromboembolism.

Congenital heart disease (CHD) is the most common congenital defect, with an incidence of about 1%. Recent advanced clinical practice concerning CHD has enabled most women with CHD to reach childbearing age, preserving normal daily life. Therefore, the number of pregnancies with CHD is increasing. The various advanced operative methods, including Fontan operation, are widely spread, and the range and severity of CHD in pregnant women are expanding. The clinical management of pregnancies with CHD requires comprehensive knowledge and experience.