Q: This is regarding my daughter, who is living in U.K. She is about 30 years old. She was operated at the age of thirteen. In this operation, her valve was replaced. As for now, she is enjoying her life. She is taking 14 mg Warfarin. She is pregnant and been told that her life can be at risk (though all precautions will be taken, she would be on injections instead of tablets) and still she wants to continue with her pregnancy. I am worried about her. Please guide me.

A:You have written this mail because you are worried. I am just wondering if you think you are the only parent who is worried! Well as far I am concerned, worrying is synonymous with parenting. I have never met a parent who is not worried, especially about health and pregnancies. On a more serious note, the main issue you have raised is the risk to her life because of the pregnancy with a prosthetic valve. Well risk to life is a possibility but if her heart condition is stable and the pregnancy well managed, she should pull through without any serious problem. The real risk really depends upon her basic heart condition. That is to say what the diagnosis is, which valve is replaced, what is her cardiac function like now, the other systems like her lungs, and how well she was managed before the pregnancy started. The exact risks can be explained best by her treating physicians. But by and large I can reassure you that if the heart function at the time of pregnancy was good to start with and the pregnancy is well managed, you do not need to worry much. There is certainly no reason at all to not to continue the pregnancy. If her general health is good and the heart condition well controlled she has every right to be a mother if she so desires. Your anxiety or worry cannot be a reason not to do so. Yes, she will have to take injectable anti-coagulants instead of warfarin, but that should not be a problem and in fact it is done as injectable anti-coagulants are safer for her and her child. The blood parameters are well monitored, and there should not be a problem.