Medical Management of Heart Disease During Pregnancy
The management of heart disease and pregnancy is determined on an individual basis. Recommendations regarding physical activity, continuing work in specific environments, and dietary recommendations need to be individualized depending on the cardiac problem. Restriction of physical activity puts a woman at risk for blood clots and, therefore, must be recommended with careful consideration. The ability to continue work during pregnancy depends on the nature of the work, the physical demands and the setting in which it occurs.
Certain medical problems need to be treated quickly during pregnancy because they can complicate the condition of a woman with underlying heart disease and impact fetal development. Specifically, any condition that increases heart rate, such as infection, overactive thyroid, or anemia needs to be quickly identified and treated.
Because pregnancy changes how drugs are absorbed, distributed, and eliminated throughout the body, there is a concern regarding the use of drugs during pregnancy. There is the risk of the drug passing through the placenta to the fetus. Every drug must be looked at carefully during pregnancy and the benefit of using the drug weighed against the potential risks to mother and fetus.
Clinical studies to assess drug use and fetal safety during pregnancy are limited and are essentially based on accumulated clinical experience. Drugs are rated by the Federal Drug Administration (FDA) into categories A, B, C, D, and X. There may be potential risk for drugs in categories A, B or C and should be used when the clinical benefit outweighs the risk and at the lowest effective dose. Category D drugs are associated with known risks and need to be used with caution. Category X drugs are contraindicated in pregnancy and should not be used.
Heart Disease and Pregnancy Program
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