A pregnant woman’s body undergoes many transformations. The normal transformations aim to support the baby’s growth and development. One of the significant transformations is the cardiovascular system. The blood volume increases significantly throughout the pregnancy in order to provide the baby’s nutritional supply. As the result, pregnant women are more likely to have anemia which increases the cardiac workload. This condition may bring the typical symptoms in women with heart defects that were not initially seen before pregnancy.
Heart disease in pregnant women is one of the causes of high maternal mortality in the world. In every country, the number varies from 1 to 4% with a tendency for higher incidence rates in developed countries. Nowadays, the case of heart disease in developing countries, like Indonesia, rises. In developed countries, heart disease in pregnancy is often caused by congenital heart disease. While in developing countries, the most common heart disease in pregnancy is acquired heart disease (CHD), rheumatic heart disease (RHD), which is caused by the infection with Streptococcus bacteria that is not treated properly.
According to a study conducted at Regional General Hospital (RSUD) Dr. Soetomo Surabaya, of 1,328 deliveries, 5.13% (69) deliveries have heart diseases. The result showed the number of CHD is higher than the AHD cases. It contradicts the other research which mentions that AHD is more common in developing countries. The high infections in developing countries made it possible, putting the risk of infectious complications of cardiac endocarditis. The inadequate treatment for CHD during toddler causes the death of the patients before the adolescence phase. A similar result in less developed areas in Australia and New Zealand also shows a higher case of AHD which is also higher than CHD cases. It means the opposite conditions can also occur in ‘developed’ regions of developing countries just as our research shows. With the possible advances in technology and better cardiac surgical procedures, the number of pregnant women with CHD reaching the reproduction phase and pregnancy rise.
As predicted, the rates of cardiac complications among women with heart disease are higher. It showed around 37.7% cardiac complications. CHD patients had an insignificantly higher cardiac complication rate than AHD patients. Heart failure was the most cardiac complication case recorded, followed by lung edema, and Eisenmenger syndrome. Fetal complications that are commonly found include preterm birth, intensive care for the baby, and perinatal death. Spontaneous preterm birth or by indications may occur. Most of the delivery methods were done in Caesarean section with indications of maternal or infant emergency.
Congenital heart disease that is not diagnosed early and delayed in treatment for the cardiac disease can worsen the morbidity and even death. Early detection of heart disease in pregnancy in antenatal care (ANC) is necessary. Apart from early detection, ANC should provide postpartum contraception education for heart disease patients. People still have low awareness of contraception. Being the method to prevent unintended pregnancy, it also pauses the women to heart disease recovery. However, in this study, it is found mothers who choose not to use contraceptive methods, even when they are at high risk of complications in the next pregnancy.
In conclusion, there is a significant change in cardiac disease in Indonesia with acquired heart disease (AHD) higher than congenital heart disease (CHD). Cardiac diseases put the mother and the unborn child at high risk. Therefore, early detection of heart disease is required to optimally treat the mother and children and prevent complications.
Author: Dr. Ernawati, dr., Sp.OG.
Puspa Pitaloka, C., Secka, A., Ernawati, E., Sulistyono, A., Juwono, H. T., Gumilar Dachlan, E., & Aditiawarman, A. (2021). Characteristics shifting of heart disease in pregnancy: A report from low middle-income country. Journal of Public Health Research. https://doi.org/10.4081/jphr.2021.2137
