Pregnancy poses significant risks for women with weakened hearts, however, with the right medical guidance and modern treatment plans, most women can consider pregnancy safely. You! takes a look...
Cardiovascular disease (CVD) is a leading cause of maternal mortality in the developed world, and Pakistan faces similar challenges. Women with conditions such as valvular or rheumatic heart disease often did not survive in the past. However, improved medical care has extended their lives, allowing these women to reach reproductive age. It is heartening to know that more women with heart disease are now surviving into their reproductive years due to advancements in cardiac treatment. Yet, pregnancy poses significant risks for women with weakened hearts, as the physical demands can lead to serious complications or even death.
Anaemia - a condition that affects many Pakistani women - further weakens the heart, placing these women at even greater risk during pregnancy and childbirth. Anaemia can lead to left ventricular hypertrophy, compromising cardiac function and making labour highly dangerous. Without intervention, the consequences can be dire for both mother and child.
The challenges that arise from increased survival rates of cardiac patients also present opportunities. As women with cardiac issues are now living longer and reaching reproductive age, healthcare providers must address the reproductive risks unique to this population.
Dr Nighat Ali Shah, head of Ward 9-B Gynaecology and Obstetrics at Jinnah Postgraduate Medical Centre (JPMC) and Focal Person for Family Planning for Tertiary Care Hospitals, Government of Sindh, highlights the life-threatening risks some of her cardiac patients face during pregnancy, “One patient with valvular heart disease collapsed during delivery and, although she was saved with CPR and later discharged after an ICU stay, she returned within six months with another pregnancy. This incident served as a critical wake-up call for us,” she shares.
In response, Obstetrics at JPMC and Cardiology at National Institute of Cardiovascular Diseases (NICVD) joined efforts to improve patient outcomes. This collaboration has since led to the successful discharge of many patients, now equipped with contraception on medical grounds to prevent repeat pregnancies until they are medically fit. The hard-learned lesson emphasised the importance of proactive contraceptive counselling and a comprehensive care approach for cardiac patients.
This case serves as a reminder of the importance of recognising specific cardiac conditions that make pregnancy too dangerous to attempt. Marfan syndrome, for instance, is a genetic disorder that affects the body’s connective tissue and can lead to weakened heart and blood vessel walls, making pregnancy a high-risk event that can result in fatal complications for both mother and child.
While such cases are rare, the absolute contraindications to pregnancy must be identified and addressed with rigorous care. Early screening, diagnosis, and proper counselling are critical in helping these women understand the extreme risks they face. In these cases, healthcare providers must offer support and compassionate counselling to help patients make safe reproductive choices, which may include avoiding pregnancy altogether or exploring other options like surrogacy or adoption if they wish to expand their families.
Fortunately, as Dr Shah explains, “Most women with cardiac disease can have children if the cardiac condition is optimised, and these women are cared for in tertiary care hospitals with combined cardio-obstetric input.”
Saima*, 30, was pregnant and already had several children. She also had a severe heart disease, which made breathing difficult, so she was admitted to the hospital at 35 weeks. Doctors found her left atrium was extremely enlarged, and her heart valve was very narrow. After special care to prepare her, she had a C-section and tubal ligation. Following the birth of a healthy baby boy weighing 2.2 kg, Saima developed an irregular heartbeat and was moved to NICVD for further care. With medication, her condition improved, and she was sent home in stable condition, with instructions to continue heart and blood-thinning medications. Her case shows the need for expert, team-based care for high-risk heart patients during pregnancy.
For many cardiac patients, modern medicine offers hope and options. With the right medical guidance and treatment plans, most women can consider pregnancy safely, provided that their conditions are well-managed in a specialised healthcare setting.
22-year-old Ayesha* faces a journey unlike most expectant mothers. Her pregnancy at 30 weeks and 6 days, already a demanding period for any woman, has brought her to JPMC’s specialised cardiac and maternal care unit. She was referred there from NICVD due to a complex congenital heart condition that has led to significant health challenges.
In her third trimester, Ayesha presented with persistent shortness of breath - a symptom made more intense by her intricate cardiac structure. Diagnosed with a double inlet right ventricle, a hypoplastic left-sided right ventricle, a large ventricular septal defect (VSD) with a bidirectional shunt, and moderate pulmonary stenosis, Ayesha’s heart bears a heavy load. Her right-sided aortic arch and pulmonary artery measurements add further complication to her case, showing dilations that require careful monitoring.
As Ayesha and her husband await the birth of their child, her care team manages her multiple diagnoses, including gestational diabetes and hypothyroidism.
“Our ward sees many cases like Ayesha’s, but each is unique,” elucidates Dr Shah. “The collaborative efforts of our cardiology and obstetrics team are crucial, and we are dedicated to supporting Ayesha and her family through this complex pregnancy,” she adds.
Ayesha’s strength and resilience serve as a beacon of hope for others facing high-risk pregnancies, particularly those compounded by complex heart conditions. “JPMC’s maternal cardiac care unit has handled 100 cases this year of similar high-risk pregnancies, making it a leader in maternal heart health management,” informs Dr Shah.
For Ayesha and her family, each day brings them closer to meeting their baby, supported by a multidisciplinary team ready to handle whatever challenges lie ahead.
The unique intersection of cardiac and reproductive health highlights the importance of counselling and contraception options for cardiac patients.
Family planning services have recently been introduced at the National Institute of Cardiovascular Diseases (NICVD) for cardiac patients of reproductive age, marking a significant advancement in women’s healthcare. This initiative aligns with the vision of Sindh’s Health Minister, Dr Azra Pechuho, to reduce maternal mortality among women with cardiovascular conditions by ensuring they receive appropriate reproductive counselling and support.
The programme is a collaboration between the Population Welfare Department, Government of Sindh, and Jinnah Postgraduate Medical Centre (JPMC), supported by Vital Pakistan, and involves a dedicated NICVD team, including Dr Hannah, Dr Sial, and the Executive Director NICVD Dr Tahir Sagheer. Given the success of the programme, similar services will soon be offered at Sukkur’s SICVD and at Tando Mohammad Khan.
At institutions like NICVD, women can receive coordinated care from both cardiologists and obstetricians under this programme, ensuring a comprehensive approach to managing their health. This type of multidisciplinary approach is essential for optimising their cardiac function before and during pregnancy, minimising the risks associated with their condition. Patients with access to this type of integrated care, stand a much better chance of experiencing safer pregnancies and deliveries.
Health Minister Dr Azra Pechuho’s vision of free and accessible cardiac care for women in reproductive age has been instrumental in developing this initiative. The partnership between NICVD, JPMC, Government of Sindh, and Vital Pakistan has allowed cardiac patients to receive family planning services, an essential addition to routine cardiac care. Counselling these women on reproductive choices and providing contraception options are key steps in minimising the risks they face if they choose to become pregnant.
This programme offers not only physical healthcare but also emotional and psychological support to women managing complex health challenges. By receiving advice on contraception and reproductive planning from trained healthcare providers, these women gain greater control over their reproductive health. The initiative recognises the multifaceted needs of female cardiac patients and provides a more holistic approach to their treatment.
The expansion of these services to other parts of Sindh, including Sukkur and Tando Mohammad Khan, represents an important step towards making comprehensive healthcare accessible to all women. For women living in rural or underserved areas, this initiative brings hope. It underscores the government’s commitment to reducing health inequities and ensuring that women in all parts of Sindh receive the same quality care.
In Pakistan, a country that has long struggled with both high rates of cardiovascular diseases and maternal mortality, initiatives like these can lead to better health outcomes for women and their families.
As Dr Nighat Shah emphasises, it is crucial that cardiac patients receive contraception counselling and family planning services as part of their regular care. By providing these resources, healthcare providers can help women make informed decisions about pregnancy and reduce the potential for dangerous health complications. These services can alleviate a significant burden on families, who may otherwise face the risk of losing a mother to preventable complications.
NICVD’s collaboration is also a milestone in shifting societal attitudes toward reproductive healthcare for women with chronic health conditions. The emphasis on family planning, rather than simply treating immediate cardiac symptoms, is a transformative approach. It encourages a preventive outlook that supports women’s autonomy and acknowledges the interconnectedness of cardiac and reproductive health.
Supported by the Sindh government, JPMC and Vital Pakistan, this initiative will help cardiac patients of reproductive age make informed choices, manage their health proactively, and avoid the severe risks associated with pregnancy. This programme is not only about protecting health -it is about empowering women with the knowledge and resources they need to lead full, healthy lives.
In conclusion, for women who may face overwhelming choices and risks, family planning represents a lifeline - a chance to understand their bodies better, make decisions that align with their health needs, and embrace motherhood if and when it is truly safe. And for those facing absolute contraindications, it provides compassionate care, understanding, and guidance in navigating one of the most critical health decisions of their lives.
*Names have been changed to retain privacy.
