In recent times, hospital statistics reveal a rise in congenital heart disease among Nigerian children. Consultant Cardiologist and Head, Paediatric Cardiology Unit, Lagos University Teaching Hospital, LUTH, Professor Christy Okoroma, speaks to Chioma Obinna about the burden of congenital heart disease. She says to check the trend, pregnancies must be planned.
Excerpts: What it is HEART DEFECT:
Studies shown that 35 percent of pregnant smokers risk baby heart defect Congenital heart disease is a major birth defect. It is the most dangerous because it can kill a child. For every 1,000 live births, you have 8 to 10 children with congenital defects. The commonest is specifically the one known as hole-in-the-heart. The burden is huge if for every 1000 live births between 8 and 10 are affected, it is a major problem. For instance, if you put it in the context of the population of Nigeria, that makes it more serious because it means one child per 100 live births.
The place to start is the risk factors but with the things that could predispose the babies to heart defects. What can predispose a born child to congenital heart disease? Some are inherited and combine with the environmental factors. The environment is little bit of a problem, but for genetics you can do a bit but not about the environment. You can talk about the diseases that afflict mothers. Nowadays people get pregnant without planning for it or without knowing. Unfortunately, the heart begins to form early in pregnancy, sometimes even before the mother knows that she is pregnant. You can imagine while the heart is forming and the mother is already consuming alcohol with herbs and other concoctions or inhaling cigarette smoke? The most important part of preventing congenital heart disease and other types of disease is to make sure that pregnancy is planned. You wouldn’t have problems if the pregnancy is planned.
A couple should agree that they want to have a baby and will go see the doctor. The doctor will now carry out medical examinations on them. And part of the things the doctor will look at includes those risk factors that can predispose babies to congenital heart disease, like diabetes, hypertension and obesity. Obese mothers are more likely to deliver big children from 4kg and above. If a child is really big the child is at risk of having heart defects or other births defects. It is surprising that some women now take concoctions in the name that they do not want their babies to be big. If a baby is too small, that baby is at risk. It is during the planning the gynaecologist will be able to pick some of those risk factors that would predispose the mother. Another example is Rubella that can predispose babies to heart disease.
Apart from alcohol, diabetes and hypertension, drugs are also important. When you abuse drugs like cocaine even antibiotics and analgesics, they can cause heart defects. It is a long list but the take home message is that people have to plan pregnancies. When we were in school, we were told that older mothers are more prone to having babies with birth defect but now we are seeing teenage mothers having babies with birth defects, not only that but other kinds of defects. Pregnancy has to be planned if a woman truly needs additional babies. Some women have four to six children already and they still need more. They need to go for family planning. If they must get pregnant again, they must see their doctors who will now identify those conditions and offer advice.
Congenital heart disorders can be detected in the womb with ultrasound or foetal echo-cardiography, (a scan of the heart). This can be done through the mother’s abdomen and heart defects can be picked up. This is why we need good spirited individuals, Foundations and organisations, to support hospitals like LUTH. We are doing well to even pick them up before they are born. With that we will plan their delivery because some of them will have problem as soon as they are born and some will be in the future. That will enable us to ensure that the equipment they are going to use are available before the finally do the definite surgery.
Role of diet
There are things that can predispose a baby to be big even before birth. If you are obese the risk of having a big baby is there and if you have diabetes the risk of having a big baby is there but you can discuss with a nutritionist who can counsel you on what to eat. If you are on the big side a dietician can advise you on what to eat. You need to work with your doctor and dietician to know the balance diet you will need to eat in pregnancy to reduce chances of having a big baby and reduce weight gain during pregnancy as well as ensure that your diabetes are controlled.
Open heart surgery
Congenital heart defects can be closed without opening the heart. The open heart surgery patient should be followed up. Unfortunately, most patients disappear once after surgery. Surgery itself can bring up more problems and some require more than one surgery to pick up post operation problems. It can reoccur in a family member. There is high risk if there is a family history. It can reoccur in another family member. If a child has heart defect, the risk in other siblings is about 4 percent. While if it happens in a mother, the risk increases to 15 percent. In LUTH, we also screen parents of children who have congenital heart disease and discuss with them and counsel them. Children who have had open heart surgeries may develop complications, hence the need to follow them up for a long time.
Preventing birth defect during pregnancy:
Eat well balanced and nutritional meals, and take a multivitamin daily that includes the recommended 400 mcg of folic acid and the B vitamins. Avoid all activities that could potentially lead to birth defects, including alcohol, tobacco, illicit drugs and caffeine Seek an annual gynaecological and wellness examination. Obtain genetic counselling and birth defect screening. Apply caution when taking certain medications and getting vaccinated. Make sure to tell your doctor about any medications (including over-the-counter drugs and supplements you may be taking. Maintaining a healthy weight also helps reduce the risk of complications during pregnancy. If you have pre-existing conditions, such as diabetes, take special care to manage your health. It’s extremely important to attend regular prenatal appointments. Additional prenatal screening can be done to identify defects if your pregnancy is considered high risk. Depending on the type of defect, it may be able to be treated before the baby is born.