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Cardiovascular disease in pregnancy: (women's health series)
Myrna Alexander Nickens1, Robert Craig Long, Stephen A Geraci
1From the Division of Cardiovascular Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, and the Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City.
Insights
Pregnancy with cardiovascular disease poses risks to both mother and fetus. Risk assessment tools help guide decisions on managing heart conditions during pregnancy for better outcomes.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Public Health
Background:
- Cardiovascular disease is a leading cause of death globally and during pregnancy.
- Increased survival of congenital heart disease and rising acquired heart conditions (e.g., coronary artery disease) in pregnant women.
- Pregnancy exacerbates cardiovascular stress, increasing risks for maternal and fetal health.
Purpose of the Study:
- To review the challenges and considerations for managing cardiovascular disease in pregnancy.
- To highlight the importance of risk assessment and informed decision-making for pregnant patients with heart conditions.
- To emphasize the need for careful selection of treatments balancing maternal and fetal well-being.
Main Methods:
- Literature review of cardiovascular disease in pregnancy.
- Analysis of physiological changes during pregnancy impacting cardiovascular health.
- Discussion of risk assessment indices and treatment strategies.
Main Results:
- Pregnancy significantly stresses the cardiovascular system, leading to potential maternal and fetal complications.
- Risk assessment tools aid clinicians and patients in understanding prognosis and making informed choices.
- Treatment decisions must prioritize maternal and fetal safety.
Conclusions:
- Managing cardiovascular disease during pregnancy requires a multidisciplinary approach.
- Informed decision-making, supported by risk assessment, is crucial for patients.
- Optimizing maternal and fetal outcomes necessitates careful consideration of treatment risks and benefits.
Abstract:
Cardiovascular disease is the leading cause of death generally and the most common cause of death during pregnancy in industrialized countries. Improvement in early diagnosis and treatment of congenital heart disease has increased the number of women with such conditions reaching reproductive age. The growing prevalence of diabetes, hypertension, obesity, hyperlipidemia, and metabolic syndrome has concurrently added to the population of pregnant women with acquired heart disease, including coronary artery disease. Physiologic changes occurring during pregnancy can stress a compromised cardiovascular system, resulting in maternal morbidity, mortality, and compromised fetal outcomes. These risks complicate affected women's decisions to become pregnant, their ability to carry a pregnancy to term, and the complexity and risk benefit of cardiovascular treatments delivered during pregnancy. Risk assessment indices assist the obstetrician, cardiologist, and primary care provider in determining the general prognosis of the patient during pregnancy and although imperfect, can aid patients in making informed decisions. Treatments must be selected that ideally benefit the health of both mother and fetus and at a minimum limit risk to the fetus during gestation.
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