Lessons from epidemiology for the care of women with congenital heart disease

Knowledge of the epidemiology of congenital heart disease can be helpful in counseling women of child-bearing age who desire to have children. Understanding the concepts of incidence and prevalence at birth can provide the woman with a perspective on the population risk as compared to her individualized risk. In particular, a woman needs to understand that she may be at higher risk for spontaneous abortion and stillbirth; she may need to contemplate fetal cardiac screening and pregnancy termination. Consideration of the syndromic or non-syndromic nature of the heart defect in the woman and in her family may provide a perspective to possible genetic etiology and the recurrence risk. Last, although knowledge of the etiology of heart defects with regard to teratogens is quite preliminary and has only occasionally been applied to prevention, this field holds tremendous potential to reduce the recurrence risk in offspring in these women who are at high risk.