Download Have Your Heart in the Right Place

Have Your Heart in the
Right Place
A discussion about cardiovascular disorders in
neonates
Juliet Ans Biju
Dr. Kiehl
Advisors: Dr. Monique Satpute and Dr. Ruth Agwuna
April 27th, 2012
Introduction
The heart performs the central function of the body as a whole so it is necessary to keep
the heart in good shape. Because it is the main functional organ of the body, the heart can easily
get damaged by many environmental causes. Cardiovascular disorders in neonates are most
commonly seen nowadays. It can be triggered from genetic causes but it also can be caused from
the environment and mothers’ behavioral changes during pregnancy. Some of the commonly
seen factors that contribute to CHD include the mothers’ daily routines and activities during
prenatal stage or pregnancy. The consumption of alcohol, consumption of drugs, smoking habit,
low activity levels, and unhealthy daily diets of mothers during pregnancy or prenatal stage will
cause cardiovascular disorders in their babies. This paper will overview the effects of alcohol on
a baby’s heart, discuss the several cardiac malformations resulting from smoking and drugs,
clarify the impacts of physical activity and diet on the heart of a baby and highlight some of the
preferable recommendations to avoid neonatal heart diseases during pregnancy.
The daily routines, habitual actions, and all the periodic activities that the mothers go
through during the prenatal stage have a huge impact on the baby’s heart. Since mothers are
directly attached to their babies, caution is needed during pregnancy, because whatever they do
during this stage will ultimately impact their babies’ hearts. The child’s growth can be affected
by the mother’s daily activities and routines. Some of the most important tasks of mothers are to
stay away from alcohol, drugs, smoking, and doing enough exercise and maintaining a good diet
as well.
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Review of Literature
First, the alcohol consumption of mothers during pregnancy can cause a vast amount of
malformations and bad impacts on fetuses and newborn babies. One highly problematic effect
from the mother includes irregular heart rhythms which are known as arrhythmias (Zachari).
“Alcohol abuse also can cause rapid and chaotic heartbeats to occur in the upper chambers of the
heart” (Zachari). Arrhythmias can happen to mothers during pregnancy and simultaneously may
or may not happen to their child. Arrhythmia is a very serious symptom in babies that indicates
the development of heart diseases in babies (Agwuna). Alcohol consumption can affect mothers
and their babies; one such effect on mothers is high blood pressure which can ultimately cause
heart diseases (Zachari). The excessive consumption of alcohol can cause strokes (Zachari).
Strokes are sudden stops in the several body parts like the brain which stops functioning
normally. Strokes can occur in the mother spontaneously which creates a higher chance in babies
to be born with heart disorders (Zachari).
At the same time, consumption of alcohol can have numerous effects specifically on the
newborn baby. No matter if the mother consumed excessively or moderately, it can still cause
the baby’s heart to form abnormalities. “Alcohol also has a mild anti-coagulating effect, keeping
platelets from clumping together to form clots” (Alcohol and Heart Disease). This anticoagulating effect will harm the normal functions of the heart. Usually, when these types of
effects impact the heart, the child will not gain weight as well; or do as many activities as the
other babies of its age (Satpute). Heavy drinking and/or excessive consumption of alcohol can
increase the excess fats in the baby and raise the triglyceride level. If fat levels are raised in the
baby, they might have trouble breathing, eating or playing. The consumption of alcohol can
cause an enlarged and weakened heart in the baby which is known as Alcoholic Cardiomyopathy
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(Alcohol and Heart Disease). This enlarged and weakened heart may potentially cause the
irregular heart rhythms and may cause the heart to perform abnormally. The enlarged and
weakened heart can also be cured during pregnancy. One such method is the ultrasound or
prenatal ultrasound (Satpute). Prenatal ultrasound helps the doctors to identify any defects of the
baby during pregnancy. It also helps the surgeons and the physicians to predict any solutions
during pregnancy.
Also, binge drinking can cause CHD in newborn babies (Zahler). Binge Drinking is the
consumption of alcohol in severe and excessive amounts, more than normal. Mothers that choose
to binge drink during the prenatal stage, may cause severe impacts on their child. First of all
binge drinking can cause arrhythmias (Zahler). Binge drinking can affect the baby’s heart with
cardiomyopathy (Zahler). Cardiomyopathy is a situation when the heart doesn’t pump enough
blood to all parts of the body (Zahler). This causes an unequal distribution of blood supply
throughout the body parts. The imbalance of blood can cause various defects with other
functional organs of the body as well. The blood transfer from the heart to the several body parts
can be inaccurate and thus functions.
Aside from binge drinking, mothers’ consumption of alcohol during pregnancy can affect
the baby with Fetal Alcohol Syndrome (FAS) (Downs). Fetal Alcohol Syndrome is a condition
when excessive alcohol is consumed during pregnancy. This can cause mental retardation,
learning disorders, behavioral problems, etc. (Fetal Alcohol Syndrome-definition and
prevention). Fetal Alcohol Syndrome does not directly affect the heart; it mainly affects the body
as a whole. The first three months of pregnancy are the most important period of pregnancy.
Alcohol consumption is considered to be the most dangerous during the first three months of
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pregnancy (Downs). It is the time that mothers should take care of their health the most carefully.
One of the most recommended methods is to avoid alcohol during pregnancy.
Like alcohol, smoking is also a very dangerous factor that contributes to heart
malformations in infants. Smoking during pregnancy can cause Cyanotic Heart Disease in babies
(Webb). Cyanotic Heart Disease is a condition where low oxygen blood levels are present during
the birth (Webb). Low oxygen blood levels can affect the flow of blood to the wrong directions
throughout the whole body. This condition also leaves an insufficient amount of blood in the
heart to function (Webb). Cyanotic Heart Disease can cause the wrong blood flow to the several
organs in the body (Webb). “Blood that is low in oxygen (blue blood) returns from the body to
the right side of the heart. The right side of the heart then pumps the blood to the lungs, where it
picks up more oxygen and becomes red. The oxygen-rich blood returns from the lungs to the left
side of the heart. From there, it is pumped to the rest of the body.” (Cyanotic Heart Disease)
This may potentially alter the functions of the organs throughout the body. Cyanotic Heart
Diseases can cause the baby’s hands, feet, toes, lips, mouth, etc to turn to a bluish color. This
bluish color is the color of the blood that has been wrongly directed to the several body parts.
Exposure to tobacco can cause the blood to flow to the ventricles of the heart (Smoking Early in
Pregnancy Raises Risk of Heart Defects in Infants). This might result in the rupture or the
damage of the ventricles of the heart. It has been determined that quitting smoking in an earlier
stage can prevent 100 cases of ventricle outflow in infants (Smoking Early in Pregnancy Raises
Risk of Heart Defects in Infants). The wrong flow of blood from the right side of the heart to the
lungs can cause Atrial Septal defect (Woolston). Atrial Septal defect is the opening in the upper
chambers of the heart (Woolston). This opening is not supposed to happen normally.
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Nicotine also plays a huge role in cardiovascular disorders. Nicotine from smokeless
tobacco can affect the blood vessels (Zahler). Excessive smoking and application of nicotine can
cause arteriosclerosis which is the hardening of the arteries of the heart (Zahler). One big
negative aspect of nicotine is that it raises blood pressure in the mothers and the heart rate of the
babies; this makes the heart of the child work faster than normal (Zahler). Physicians suggest
stopping smoking will possibly increase the ratio of HDL cholesterol to LDL cholesterol
(Zahler). Good cholesterol is HDL and bad cholesterol is LDL (Newell). The excessive smoking
of mothers during pregnancy can cause Coronary Heart Disease in the babies (Effects of
smoking on the heart). This will affect the heart with a diminished blood flow in the coronary
arteries of the heart (Effects of smoking on the heart).
Smoking can cause harmful effects on heart which can cause the heart rate to rise and
increase blood pressure in mothers which will eventually affect the baby’s heart (Effects of
smoking on the heart). Cigarette smoking will make the baby’s blood vessels contract which will
make it difficult for the heart to deliver oxygen to the body (Effects of smoking on the heart).
Excessive cigarette smoking will raise the cholesterol levels in mothers during pregnancy which
can affect the baby’s heart with malformations (Effects of smoking on the heart). “The chemicals
in tobacco smoke harm your blood cells. They also can damage the function of your heart and
the structure and function of your blood vessels. This damage increases your risk
of atherosclerosis.” (How does Smoking Affects the Heart and the Blood Vessels) This is a
condition in which the fatty substances called plaque accumulates in the arteries; it will also
narrow down the arteries from its normal positions and functions (How does Smoking Affect the
Heart and the Blood Vessels). Atherosclerosis also limits the flow of oxygen to the different
parts of the body (How does Smoking Affects the Heart and the Blood Vessels). Increased
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smoking will cause Peripheral Arterial Disease (PAD) which is a disease where plaque builds up
in the arteries that carries blood to the limbs, head and many other organs (How does Smoking
Affects the Heart and the Blood Vessels). This condition is very serious because once the heart is
unable to deliver the blood that is needed to the respective body parts, these body parts will
eventually slow down their functions which may potentially affect the whole body in general
with several defects.
Apart from smoking, drugs play a crucial role in neonatal heart diseases. One of the most
readily seen drugs is Cocaine. Mothers’ consumption of cocaine can disturb the baby’s heart
rhythms. It can affect the baby’s heart with irregular heart rhythms (Arrhythmias) (Zahler).
Consumption of cocaine can cause chest pain, cause the blood vessels of the baby’s heart to
“constrict” which may possibly shrink the heart of the child, speed up the heart rate of the babies
and clump the platelets and form blood clots (Zahler). The clumping of the platelets will restrict
the blood flow in the baby’s heart. Because of this, the heart will fail to do its process of
distributing blood to several body parts.
Another type of drugs is Intravenous Drugs- IV. One such drug is Heroin. Heroin can
cause Endocarditis (Zahler). Endocarditis is a condition when the heart valves are affected by
bacteria and fungi. Bacteria like “staphylococcus” can damage the heart valves (Zahler). Bacteria
can contaminate the surface of the heart also. Amphetamines are another group of drugs that will
affect badly if the person has a very strong background of heart diseases. They raise blood
pressure and heart rate of the baby (Zahler).
In addition to drugs, physical activity of mothers during pregnancy will impact their child.
Moms who exercise during pregnancy have a lesser chance of the development of heart disoders
in their babies. They will also have a lower risk of developing diabetes or high blood pressure
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(Fetal Effects of Exercise During Pregnancy). Regular exercise of mothers improves the
development of the heart of the baby (Physical Activity- Exercise’s effects on the heart).
Exercise can also pump more blood to the body which makes the heart work without any extra
strain (Physical Activity- Exercise’s effects on the heart). Exercise will also keep the mothers
heart healthy, such as reducing inflammations in the arteries of the mothers and keeping the
blood vessels to be elastic, flexible and less strained so therefore, it ensures the good blood flow and
normal blood pressure in mothers (Physical Activity- Exercise’s effects on the heart). Exercise
improves cholesterol levels and fat levels in mothers (Physical Activity- Exercise’s effects on the
heart). Good exercise keeps the bad cholesterol level low in mothers, which creates a much
lower risk for the development of heart diseases in babies.
“Other good types of exercise include low-impact aerobics, stationary cycling, and
stretching. Regular exercise of any kind is important and should be done daily if possible.
Simple exercise like walking, hiking, and swimming can be done without much guidance, but
that women should seek help from a personal trainer or instructor with pre-natal training for
pilates, yoga or weight training.” (Miller)
These are some recommended exercises that pregnant women should consider doing. Some
exercises that pregnant women should avoid during pregnancy are explained in the quote below:
“Any sport or exercise that could injure a woman's stomach or cause her to fall should be
avoided. Gymnastics, horseback riding, and downhill skiing are examples of activities to avoid.
Scuba diving is also not recommended” (Miller).
Beyond physical activity, diets of pregnant mothers also play a crucial role. High salt diets
can cause high blood pressure in mothers that will ultimately lead to cause congestive heart
failure in babies (Newell). The consumption of too high salt levels will cause the heart to pump
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which can increase the pressure against the blood vessels. High salt levels can cause fluid
retention which will make the heart to work harder and can cause heart failures (Newell). Canned
and processed foods can have serious effects on the mother and on their child as well (Newell).
A high diet in fat especially from fats and Trans fats can cause heart problems. These processed
and canned foods have good and bad cholesterol in them (Newell). LDL cholesterol can cause
plaque buildup in the blood vessels which raises the high blood pressure or any other heart
failures.
Some of the recommended foods that can be consumed during pregnancy are explained
below: “A new study done by U.S researches and was published in the Journal of Food
Biochemistry suggested that type two diabetes and high blood pressure could be controlled by
eating soy yogurt, and it is better if it included fruit” (Bad Diet Causes Heart Disease, Good Diet
Prevents It). Soy yogurt controls enzymes that cause high blood pressure (Bad Diet Causes Heart
Disease, Good Diet Prevents It). Another food source that helps in preventing heart diseases is
chili. Chili helps to reduce heart diseases (Bad Diet Causes Heart Diseases, Good Diet Prevents).
Chili heat is converted to the body and reduces the calories in mothers. Mothers can consume
the recommended foods to avoid high blood pressure which might cause heart diseases (Bad Diet
Causes Heart Disease, Good Diet Prevents It).
Research Methods and Data Collection
For data collection, five interviews were conducted with pediatricians and pediatric
cardiologists and they were asked the same questions relating to the topic. It was requested to the
primary advisor Dr. Ruth Agwuna to give information about any colleagues that she might know
to conduct interviews for the data collection. Four pediatricians were suggested by Dr. Agwuna
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who are her colleagues. One of the interviews was conducted with Dr. Agwuna herself (this was
not turned in for the interview assignment back in December).
Interviews were conducted with:
1. Dr. Ruth Agwuna, Pediatrician
2. Dr. Janet Scheel, Pediatric Cardiologist
3. Dr. Ejemeh Okojie, Pediatrician
4. Dr. A. Ajayi-Akintade, Pediatrician
5. Dr. Asiedu, Pediatrician
See Appendix A for the interview questions
Results and Data Analysis
The problem that was focused for the research was on the several causes or leading
factors that cause cardiovascular disorders in neonates and how that may affect the baby’s heart.
It was hypothesized that mothers’ consumption of alcohol and drugs, smoking habit, exercise
and daily diets can cause cardiovascular disorders in neonates. For data collection, interviews
were conducted with five different pediatricians. Some of them were colleagues with one of the
primary advisors Dr. Ruth Agwuna. One interview was conducted with the primary advisor
herself. They were asked about the different causes, treatment options of cardiovascular
disorders in neonates, their personal experiences etc. Most of the pediatricians said that
chromosomal abnormalities and inherited genes can cause heart diseases in babies. They also
agreed on the fact that mothers’ consumption of illicit medications and drugs like cocaine, some
infections during pregnancy like German measles, their age can also affect the baby’s heart. If
the mother has Diabetes, that gives a higher risk of developing heart diseases in babies. Pediatric
cardiologist, Dr. A. Ajayi-Akintade said that there isn’t exactly a specific factor that causes
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diseases in a baby’s heart. Dr. Agwuna and pediatric cardiologist Dr. Janet Scheel said that the
exact causes are unknown.
When asked if the consumption of alcohol and drugs and smoking habit of mothers
during pregnancy, Dr. Agwuna said that it can definitely cause heart diseases in babies because
they are toxic to the heart and Dr. Scheel also said that consumption of alcohol and drugs can
make the heart smaller, affect their heart muscles and they will certainly affect the initial stages
of the heart development (first 12 weeks).Pediatrician, Dr. Ejemeh Okojie said that alcohol and
drugs can only cause heart diseases to some extent. On the contrary Dr. Akintade said that
alcohol doesn’t play any role on the heart but it does on the brain. Pediatrician Dr. Asiedu also
said that alcohol and drugs don’t play a role in heart diseases.
The treatment options for heart diseases in babies vary according to the responses during
the interviews. Most of them highlighted that several surgeries can be done under the supervision
of a cardiac surgeon. Before birth, ultrasound can be used to detect any heart rhythm variations
and also to view the fetus. Dr. Akintade said that it’s unusual to treat the child while still in
womb; it’s better to do anything when the child is out so the whole anatomy can be viewed much
clearly. If the defects are small, they will go away on its own without any interference like the
chambers for Atrial Septal Defect, will close by themselves if they’re small enough. But Dr.
Scheel responded that during pregnancy, heart diseases can’t be cured but they can be corrected
after birth surgically. An echocardiogram is also used to check the fetus. Another way to detect
any heart problems during pregnancy is to pay attention to the heart rhythms of the baby. If it’s
going too fast or too slow, that is something that should be reported to a pediatrician.
Exercising during pregnancy does not have an effect on the baby’s heart. According to
Dr. Agwuna, exercising during pregnancy is not completely proven yet; it’s only a possibility.
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Some agreed on the fact that they have not heard of exercise being a reason for cardiovascular
disorders in neonates. Bad diets during pregnancy is also a possibility and is not proven yet. It’s
been recalled that there needs to several nutrients that the mother should consume during
pregnancy in order to have a healthy baby. If not, they will be born in a smaller size and won’t
have any effects on the heart.
Everyone who were interviewed are pediatricians or pediatric cardiologists, they’ve had
to face situations that dealt with very serious cases. Dr. Agwuna had to take the delivery of a
blue baby and was sent to another hospital. It was found that the baby underwent Tetralogy of
Fallot and a surgery was done. Dr. Akintade had an experience where the child was born without
the four chambers and with the aorta coming from the wrong chamber which will ultimately
make the blood with oxygen mix with the blood that doesn’t have oxygen which will make the
baby blue. Dr. Scheel runs a Pediatric Transplant Program for babies who are born with heart
diseases. Some of the best ways that mothers can do to prevent heart diseases are to avoid certain
medications that might be harmful to the child, staying healthy and maintaining a good diet, not
exceeding exercise levels, avoiding alcohol and drugs, staying away from smoking. If they’re
diabetic, they should have their glucose levels under control; they should also take rest and eat
well.
In the beginning of the year, the title of the project was Congenital Heart Diseases
(CHD). It was hypothesized that mothers’ consumption of alcohol and drugs, smoking habit,
exercise levels and bad diets can cause CHD. But from the interviews it was unanimously said
that for the most part, CHD is not caused from alcohol, drugs or smoking; it’s mainly triggered
from inherited genes and chromosomal abnormalities. The word “congenital” means born with
genetic causes and the research was looking at how environmental factors can cause heart
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diseases in infants. It was misunderstood that congenital heart diseases were caused from
environmental factors like alcohol and drugs consumption. So, the title of the project was
changed from Congenital Heart Diseases to cardiovascular disorders in neonates which is a much
more generic and broad title.
Discussion and Conclusion
The responses from the several different pediatricians are similar and different in various
ways. The exact causes are really unknown but it’s mostly seen as the mothers’ prenatal behavior
and genetics that causes cardiovascular disorders in neonates. Looking at diets and exercises, it’s
not exactly been proven and researchers are conducting a lot of study on it; it’s only a possibility.
Some pediatricians said that they have never heard of exercise and diets causing heart diseases in
babies. Drugs like cocaine can impact the baby’s heart with diseases if consumed by the mother
during pregnancy. All the pediatricians that were interviewed unanimously said that smoking,
alcohol and drug consumption can cause cardiovascular disorders in neonates.
Keeping the heart healthy is one of the most important things that everyone should be
aware of; especially pregnant mothers during pregnancy. Babies do not know anything when
they are born, but as they grow and develop, anything that was passed on to the babies from their
mothers can definitely affect them. Mothers should stay away from drugs, alcohol and smoking
and always do the recommended exercises and keep healthy diets just for the sake of their
babies. They should always consult their doctors frequently about their child’s development and
to make sure that they are on the right track with their daily lifestyles. There is no “safe zone” for
drinking, and pregnant mothers should stay away from alcohol and drugs. Otherwise, mothers
will be putting their babies into a situation that will be very hard to untangle.
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Appendix A
These were the questions that were asked:
1. What are some of the main concerns of Congenital Heart Diseases? In other words, what
are some of the causes or leading factors that can affect a baby’s heart?
2. Can the mothers’ consumption of alcohol, consumption of drugs, their smoking habit
affect a baby’s heart?
3. Can diseases like Atrial Septal Disease, Tetralogy of Fallot, Ventricular Septal Disease or
any other heart disease be cured over the development and growth of the child? If so,
what are the treatment options?
4. Are there any specific types of treatment options that you or your organization deals
with?
5. Exercising daily is very important. So can the lack of exercise of mothers during
pregnancy cause Congenital Heart Diseases (CHD)? If yes, what are the complications?
6. Mothers’ may have bad diets, so can that affect the baby’s heart?
7. If any, please elaborate on an experience or event that you or your association have faced
that dealt with Congenital Heart Diseases. Like do you remember any specific
people/specific child that had one of the most serious complications and what you did to
cope with that?
8. How can pregnant mothers avoid the risk of their babies getting CHD during pregnancy?
9. How can CHD be detected during pregnancy? Is it by ultrasound or are there any other
ways to detect CHD?
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