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Medical Edge Newspaper Column from Mayo Clinic
ONE-TIME HEART PATIENT SHOULD APPROACH PREGNANCY CAREFULLY
DEAR MAYO CLINIC: I’m 55 and recently married a lovely gal, who
just turned 38. It’s a first for both of us. I knew she had congenital
heart disease surgery as a child and thought it was cured. So did she.
But during the open enrollment period for my health insurance, our health
assessment specialist seemed concerned. Here’s our question: Did the surgery
my wife received as a child fix her heart or not? Her annual checkups
are OK; she’s not overweight and doesn’t smoke. We were thinking we’d
like to start a family. Is that a concern? — Macon, Ga.
ANSWER: The good news is that most women with congenital heart disease
can have a baby. There are so many kinds of congenital heart disease,
however, that each person needs to be assessed carefully before getting
pregnant. Very few surgeries for congenital heart disease offer a complete
“cure,” and there may be residual problems even if the patient has no
symptoms. This means that it is very important that every patient periodically
have a checkup with a cardiologist who has expertise in adult congenital
heart disease.
When a woman gets pregnant, she carries not only a child but also about
50 percent more blood volume in her circulatory system. That’s a lot of
extra work for the heart. Because of this, I would strongly recommend
that your wife see a cardiologist with expertise in congenital heart problems
and pregnancy before she becomes pregnant.
At that time, she would have a clinical evaluation, an echocardiogram
— a noninvasive ultrasound test to look inside the heart — and probably
a test to make sure she has good exercise capacity. Then, the two of you
and the doctor could discuss the test results and any lingering issues
or concerns.
You should know that there also is a small risk for the baby to inherit
congenital heart disease. (With special ultrasound, doctors can screen
the baby’s heart to detect defects at about 22 weeks of pregnancy.) However,
most women with congenital heart disease (over 95 percent) have normal,
healthy babies.
If you decide to move forward with plans to start a family, consider going
to a special center where your wife can receive coordinated care from
a cardiologist and a high-risk obstetrician.
Carole Warnes, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester,
Minn.
Addidtional Resources:
Congenital
Heart Disease
Appointment
Information
More
Information on Pregnancy
DEAR MAYO CLINIC: Is it possible to become a Type 1 diabetic if
you were first diagnosed as a Type 2 diabetic? — Waco, Texas
ANSWER: The answer to your question, and the definitions of Type
1 and Type 2 diabetes, aren’t straightforward.
First, the definitions:
Type 1 diabetes is an autoimmune disease in which the pancreas makes little,
if any, insulin, resulting in abnormally high blood-sugar levels. It was
formerly called juvenile diabetes because it was most often diagnosed
in children. It was also called insulin-dependent diabetes because patients
require insulin injections.
Type 2 diabetes is far more common than Type 1, accounting for 95 percent
of people over age 20 who have diabetes. Type 2 occurs when your body
becomes resistant to the effects of insulin, or your pancreas produces
some, but not enough, insulin to maintain a normal blood-sugar level.
Type 2 was once called adult-onset diabetes; it mostly affected adults.
It also was called noninsulin-dependent diabetes because most people didn’t
need insulin shots and could manage their diabetes with diet, exercise
and oral medications.
The old names were dropped because they weren’t accurate. More and more
children and teens are developing Type 2 diabetes, and some need insulin.
Obesity is a major risk factor for Type 2 diabetes, and the rise in childhood
obesity is responsible for this corresponding increase in diabetes.
Some confusion about Type 1 and 2 is semantics. If you’re diagnosed with
Type 2 diabetes and need insulin within a year of diagnosis, the diagnosis
often is changed to Type 1 diabetes. But others who have Type 2 diabetes
and need insulin several years after diagnosis are still considered to
have Type 2 diabetes.
Both types of diabetes are serious. Elevated blood-sugar levels can damage
your heart, eyes, nerves and kidneys.
Eating right, maintaining a healthy weight and getting plenty of exercise
can help prevent Type 2 diabetes. And if you have diabetes, diet and exercise
along with medications that control blood sugar can help you continue
to live a healthy and active life.
Diana Dean, M.D., Endocrinology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Treating Diabetes
Appointment
Information
More Information
on Diabetes
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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