Pregnant women with heart disease should give birth at no later than 40 weeks gestation, beyond that harm can be caused to the mother, new guidelines by the European Society of Cardiology (ESC) recommends. Besides pre-pregnancy risk assessment and counselling, a delivery plan should be devised at 20-30 weeks, specifying vaginal or caesarean delivery, whether an epidural or forceps will be used, and the duration of hospital stay after delivery, the guidelines said. "Pregnancy is a risky period for women with heart disease because it puts additional stress on the heart, so the guidelines advise inducing labour or a caesarean section at 40 weeks," said Jolien Roos-Hesselink, Professor at the Erasmus University in Rotterdam, Netherlands. "Beyond 40 weeks, pregnancy has no added benefit for the baby and may even have negative effects," Roos-Hesselink added. Heart disease is the main reason women die during pregnancy in western countries, because they have a 100-fold greater risk of death or heart failure than their healthy peers. An estimated 18-30 per cent of the offsprings have complications and up to 4 per cent of neonates die. The new guidelines, published in the European Heart Journal, also recommended against in vitro fertilisation (IVF), contraception, and termination of pregnancy for women with heart disease. It is because IVF often uses high doses of hormones, which increases the risk of thrombosis and heart failure, so women with heart diseases need a cardiologist's confirmation. "Since carrying more than one baby puts more stress on the heart, women with heart disease undergoing IVF are strongly advised to transfer a single embryo," the guidelines said. While women with heart disease can have a healthy pregnancy, they should be aware of a higher risk of obstetric complications including premature labour, pre-eclampsia, and post-partum bleeding. Moreover, girls with congenital heart disease should take advice before using contraceptives because some methods are contraindicated in patients with certain types of heart disease, the guidelines noted.