Her youngest is now 2 and thriving. But Alyssa admits she was nervous her entire first pregnancy because she'd had miscarriages not related to her heart defect. "I was fearful it might happen again and just out of protectiveness did not let myself buy a single thing for the baby until 30 weeks. Even then, I was really scared until she was born." The extra monitoring actually reassured her somewhat, she says, about other issues besides those related to her heart.

The congenital heart problems the doctors see are nearly as varied as the women who come to them wanting to have children or already expecting, says Brann. They've seen patients who have holes in their hearts that were never fixed, as well as patients with heart-rhythm problems, the after-effects of rheumatic fever, or valve problems that require the use of blood thinners.

Some women have the wrong chamber pumping blood, or the heart pumps weakly. When a women has severe narrowing of one heart valve and is pregnant, it's "incredibly risky," Brann said.

"We love to be involved in the process before a woman gets pregnant," he says. "It's so much easier to go in knowing, and often we can fix it." A repaired valve problem, for instance, may remove the excessive risk. "We like to do what we can to get the heart ready for pregnancy."

Treatment may include bed rest and careful monitoring or early delivery. For some, it's more complex than that. Medications have to be carefully considered because some should not be used in pregnancy.

Brann notes that some congenital heart defects require lifelong monitoring, even after they're repaired. Tetralogy of Fallot, which involves four heart malformations, for instance, has been linked to heart-rhythm problems 30 years later.

---

E-mail: lois@desnews.com