New guidelines for the care of unborn babies with heart problems have been developed by fetal heart experts working with the American Heart Association.
In their statment, "Diagnosis and Treatment of Fetal Cardiac Disease" - published in the American Heart Association journal,Circulation - the fetal heart experts make the case that fetal care is no longer solely a concern for obstetricians and neonatologists, as a new multidisciplinary specialty of "fetalcardiology" has emerged.
"We created these guidelines to provide pediatric cardiologists, obstetricians, maternal fetal specialists, radiologists, nurses and other health care providers with the latest developments in the rapidly developing area of fetal cardiology," explains Dr. Mary T. Donofrio, lead writer of the statement and director of the Fetal Heart Program and Critical Care Delivery Service at Children's National Medical Center, in Washington, DC.
Dr. Donofrio adds that the new guidelines take into account the latest developments in high-resolution ultrasound, three- and four-dimensional echocardiography, magnetic resonance imaging, fetal electrocardiography and magnetocardiography.
Under the new recommendations, pregnant women with specific risk factors should be referred for fetal echocardiography, which examines the heart of the fetus using sound waves.
These risk factors for mothers include:
- Having had diabetes before pregnancy
The new guidelines take into account the latest developments in advanced imaging technologies.
- Having diabetes diagnosed in the first trimester
- Having taken NSAIDs in the third trimester
- Having congenital heart disease or a close relative with congenital heart disease, or other specific maternal medical conditions
- Having conceived using in vitro fertilization.
Risk factors for the fetus include being identified with a chromosome abnormality or a suspected heart problem. Fetuses with these problems should be carefully monitored, the new guidelines say, and the required post-delivery care should be planned in advance by the health care providers.
The guidelines also now state that some fetal heart rhythm disturbances and heart abnormalities can be treated via medicines administered to the mother, which will reach the fetus via the placenta.
The guidelines acknowledge that although fetal surgery and in-utero heart catheterization are being performed, they are still considered experimental treatments.
Psychological suffering of families should
be addressed by health care providers
Depression and the psychological effects that pregnant women and their families may suffer from when coming to terms with an unborn baby having a congenital heart defect are also now taken into account in the guidelines.
The authors stress the urgency of health care providers supplying the families with information in an unbiased way - not only on the condition and treatment required, but also on how the child's heart problem might affect their school life, ability to play sports and what ongoing support may be needed.
The recommendations suggest that health care providers should take an active role in helping families overcome depression and anxiety, in order to become effect carers for their baby.
"Congenital heart disease is the most common birth defect that can result in either death or significant health problems in newborn babies," reminds Dr. Donofrio. "Despite this, more than half of babies with congenital heart disease go undiagnosed before birth."
"This document transcends specialties and gives all health care providers that practice fetal cardiac medicine a standard for practice. This means improved care for babies with congenital heart disease, starting in the womb and continuing after delivery and through their lives."
In January, Medical News Today reported on a study published in the BMJ that found childrenwho were small as fetuses grow to have significantly greater risk factors for heart diseasethan children who were larger as fetuses.