3. Can these heart defects be prevented?

Can anything be done to prevent these heart defects?

          Although there are no clear cut causes of birth defects of the heart it has been seen that vitamin and folic acid supplements can have a beneficial effect in reducing the incidence of these defects. Folic acid is also of benefit in preventing spine defects in the baby. This is most effective if taken even before conception. So, if you are planning to get pregnant, start folic acid supplements before you start trying for a baby.

          The other important precaution you can take is to make sure that you have been immunized against rubella. This is routine nowadays as part of the vaccination program but if you have a doubt about whether you have been immunized you can get your antibody level checked. If you have not been immunized you should get immunized before you get pregnant.

Image of the unborn baby's heart (normal in this patient)

Apart from these measures the only other thing you can do if you are a high risk mother is to get a fetal echo-cardiogram done to detect abnormalities early in pregnancy.

2. On the same subject of birth defects of the heart detected during pregnancy

Are there certain mothers who are at higher risk of birth defects of the heart?

          

          Certain mothers can be at higher risk of having babies with birth defects of the heart. However this risk is still very small. So, if in normal population the risk of having a baby with a heart defect is 1 per 100 (1%), this risk increases to 2-5 per 100 (2-5%) in high risk mothers. So even in high risk mothers more than 95% of the babies will have a normal heart.

Who are the women at a higher risk of having a baby with a heart defect?

·         Diabetic mothers

·         Family history of previous child with heart defect or if one of the parents has a heart defect

·         Detection of other abnormalities in the baby e.g. spine, kidney problems

·         Exposure of the mother to rubella infection (fever & rash) during pregnancy

·         Mothers who have undergone IVF treatment

What should these ‘high risk’ mothers do?

          These mothers should have an early anomaly scan followed by a specialized scan of the heart of the unborn baby. This scan is called a fetal echo-cardiogram and can be performed at 16-18 weeks of pregnancy. Here the baby’s heart is examined in detail to look for any abnormalities. When performed by skilled and trained professionals this scan will pick up most of the major abnormalities.

What can be done if there is a heart defect?

          The majority of heart defects are now treatable. Minor defects may need no treatment at all. Some might need only medications or minor procedures. Very complex heart defects may be more difficult to treat. So, deciding what to do if a heart defect is picked up in a pregnant woman depends on what the defect is, whether treatment is available and of course what the parents and family want to do. The doctors involved in the care of the pregnant woman will need to discuss with the family the options that are available to manage their pregnancy.

1. What leads to birth defects of the heart?

        Birth defects of the heart occur in approximately 8 out of 1000 live births i.e. roughly 1% of all babies born alive. It is one of the most common birth defects.

So, what leads to heart defects like holes in the heart or valve blocks in babies?

Unfortunately there is no single answer to this question. The majority of times there is no explanation as to why a patient has developed a certain heart defect. If you take patients with heart defects roughly 10% have some identifiable genetic problem. Of course there are still thousands of genetic problems that we are yet to discover. If a baby has a genetic problem (e.g. Downs Syndrome) there is roughly a 30% chance that the baby will have a heart defect. This defect may be minor requiring no treatment or major requiring some form of surgery or key hole treatment.

What about the mother’s health? Does this play a part in giving rise to heart defects?

          

       I commonly come across parents who feel guilty and responsible for their baby being born with a heart problem. It is important to understand that the majority of heart defects have no known cause and are not due to anything that might have occurred during pregnancy. The heart structure is formed very early on in pregnancy (8-10 weeks), sometimes even before the lady realizes that she is pregnant. Any abnormality of the heart is ‘programmed’ into the cells even beforehand. So, eating certain foods or undertaking certain activities does not give rise to heart defects.

What is the purpose of this blog spot?

     Having trained and worked in the UK in a system where communication with patients and their families along with their active participation in care and decision making is the norm I am keen to develop this practice back in India. 

     I believe that patients and parents deserve and need to know and understand their/their child's health and illnesses. It is the responsibility of their doctor and other health care providers to help them in this process. 

     In my line of work I deal with complex birth defects of the heart and perform difficult keyhole procedures. Although at times it is tempting to simplify the situation and presume that the patient or parent will not understand I always remind myself to explain the problem using simple language and drawings so that the patient or parent has an opportunity to understand the important issues and can then become an active participant in their or their child's care. 

     In this blog spot I aim to post information related to congenital heart disease (birth defects of the heart) including available procedures and treatments. This information can be accessed by general public and I will then try to answer any questions or queries that arise from these posts. Of course you will have the opportunity to discuss any other issue related to your or your child's heart defect on this forum. Remember that I am a specialist in congenital heart defects (birth defects of the heart for example holes in the heart, valve problems etc) and not in heart attacks that happen in later life. 

     I eventually want parent groups to take shape through this forum where patients and their parents can form their own self help groups to assist each other through their difficult times of illness. 

     Birth defects of the heart can be picked up in all age groups ranging from the unborn fetus (during pregnancy) through childhood and adolescence to the full grown adult. As the name suggests these defects are present from birth but may be detected at various stages in life. Sometimes in a high risk mother (I will explain what a high risk mother is in a separate post) a scan during pregnancy can pick up a defect in the heart. At other times the defect may be detected soon after birth due to blueness of the baby. Sometimes a routine visit to the child specialist can help pick up the problem. Rarely the problem gets noticed only during adult life. 

Anyway, time to sign off now. Will see you again :)