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Part I: How to know if your unborn child is at risk for a CHD

Getting pregnant, and getting ready to welcome a new life into the world is both exciting and terrifying in equal amounts. With Genesis Foundation’s focus on CHD, we have collated some quick facts to refer to if you’re an expecting mother or planning to get pregnant in order to know whether your child may be at risk of CHD, and the questions you should be asking your gynaecologist during your ultrasound, to ensure you baby is growing healthy inside you.

We've put together the following information from reliable sources and are attaching the links for the same at the bottom of this blog. Do remember not to treat the following details as akin to professional medical advice and do get in touch with your gynaecologist or trusted healthcare professional for further information you might need.

It is important to remember that most cases of Congenital Heart Defects (CHD) have no known cause. However, some types of CHD are known to occur more often when the mother comes in contact with certain substances during the first few weeks of pregnancy, while the baby's heart is developing.

Women who have seizure disorders and need to take antiseizure medicines may have a higher risk for having a child with congenital heart disease, as do women who take lithium to treat depression.

Mothers who have phenylketonuria (PKU) who do not adhere to the special diet needed to manage the disease during pregnancy have a higher risk of having a child with congenital heart disease.

Also, women with insulin-dependent diabetes (particularly if the diabetes is not well-controlled) or lupus may have a higher risk of having a child with heart defects.

Mothers with connective tissue disorders are also at higher risk for having a child with CHD.

A mother who contracts rubella during her pregnancy has a very significant chance of having a baby with birth defects, including congenital heart disease.

Pregnancy conceived by assisted reproductive technology (ART) has a higher rate of congenital heart diseases as compared to pregnancies that were naturally conceived.

Consultation with a genetic counsellor or genetic specialist is encouraged for women with congenital heart disease before becoming pregnant. In families with CHD either in the parents or prior children, Fetal Echocardiography can be done in the second trimester, at about 18 to 22 weeks of pregnancy, to look for the presence of major heart defects in the fetus.

Once you are pregnant, it is always best to be prepared, especially if you have any of the above proclivities to give birth to a child with CHD. Here are some questions to ask during an ultrasound exam, answers that will come during a Fetal Echocardiography.

Is the heart rate normal?

Do you look at the arteries as part of your scan?

Are the heart and stomach in the correct position?

Do you see four chambers?

Is the heart function normal?

Are there two upper chambers (left and right atria), each with a valve controlling blood flow out of them?

Are there two lower chambers (left and right ventricles), each with a valve controlling blood flow out of them?

Do the two vessels leaving the heart (aorta and pulmonary artery) cross each other as they exit?

Is the wall between the two lower chambers intact, without any holes?

Is everything else in the heart normal?

We hope the above helps you to start a dialogue around CHD, a disease about which many in India remain unaware. Genesis Foundation is an organisation that is attempting to make a difference in this largely neglected space in the healthcare scenario in India, where the burden of Congenital Heart Defects is very high due to the high birth-rate, and unfortunately children born in developing countries do not get access to timely care leading to high morbidity and mortality.

Following are links that you may be able to access further information from:

https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=p01788

https://www.rd.com/advice/parenting/congenital-heart-defects/

- Contributed by Ranjini Nair