Life goes on
As more children survive congenital heart defects, they can grow up to be parents
Friday, July 25, 2008
For Aurora nurse Kim Hammelman, getting pregnant and suffering a miscarriage caused her to have a change of heart.
"I got pregnant on my own, not knowing that I could get pregnant," Hammelman says. But after the miscarriage, she and her husband decided to seek professional advice before they tried again.
That’s because Hammelman was born with a rare congenital heart defect called double outlet right ventricle. The defect means that both the aorta and pulmonary artery exit from the right ventricle of the heart, causing strain on the heart and lungs.
Hammelman, a pediatric nurse herself, says she figured the defect would affect her ability to carry a pregnancy and was referred to Northwestern Memorial Hospital cardiologist Marla Mendelson by the pediatrician for whom she works.
"(Dr. Mendelson) did some tests and says the pressure in (my) lungs was a little bit high but (I) wasn’t in any distress," Hammelman says. Mendelson told Hammelman it was fine for her to get pregnant, and she did.
Thanks to advances in the treatment of children with congenital heart defects, more women with such defects reach adulthood and want to get pregnant, much like Hammelman. However, these pregnancies are often considered too risky because of the strain pregnancy puts on a mother’s heart.
"When women who are pregnant develop any kind of medical problem, there’s always a reluctance to treat these patients," says Mendelson, who created the heart disease and pregnancy program at Northwestern Memorial.
The program offers a multidisciplinary approach to pregnant women with congenital heart defects and heart disease by bringing in specialists from maternal fetal medicine, reproductive genetics, anesthesia and cardiology. The program has followed more than 2,000 women since its inception in 1990.
"The goal of the program is to facilitate safe pregnancy for both mother and baby," says Mendelson. "It used to be if you have this problem, you don’t get pregnant. But now, (women) can if they take a few steps."
The first step is monitoring the mother’s heart closely. "During pregnancy, to sustain the second circulation (of the baby), the blood volume increases 50 percent," Mendelson says. "The major stress starts at about 22 weeks (when) cardiac enlargement and cardiac output reaches its peak and then levels off."
Mothers with congenital heart defects also see a maternal fetal specialist to make sure the defect is not passed down to their child. If a mother has congenital heart defect, the risk of a child inheriting the defect ranges from 2.5 to 18 percent, with an average risk of 6.7 percent, according to Children’s Hospital Boston. The risk for a mother without a heart defect giving birth to a child with the defect is 1 percent.
Mendelson recommends a fetal echocardiogram at 22 weeks to see if the baby has congenital heart disease. "There are things that can be done right at the time of birth that can treat it," she says.
Hammelman has given birth to two children, Richie, 6, and Rachel, 2. Neither have congenital heart disease. But to monitor the pregnancy, Hammelman recommends that mothers-to-be who have congenital heart disease go to a clinic such as the one at Northwestern.
"Not only to see if they are well enough to carry a pregnancy, but Northwestern knows all the risks and they can take care of you and, if you do get pregnant, your child."
Hammelman now tells parents she sees at her job as a pediatric nurse not to worry about their children with congenital heart defects. "Your child will grow up, just like I did," she tells them.
Shannon Donohoe is a student at Northwestern University’s Medill School of Journalism. She wrote for Medill Reports, a news wire service in the spring.