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Published on: August 13, 2019
Drugs and therapeutics, including contraception, for women with heart disease
Aarthi R Mohan1, Catherine Nelson-Piercy1
1Guy's and St Thomas' Hospitals NHS Foundation Trust, Women's Health Services Directorate, 10th Floor, North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
Insights
Cardiac disease is the leading cause of maternal death in the UK, with numbers rising over 30 years. Management focuses on optimizing maternal health during pregnancy and delivery to minimize cardiovascular risks.
Area of Science:
- Cardiology
- Obstetrics & Gynecology
- Public Health
Background:
- Cardiac disease is the primary cause of maternal mortality in the UK.
- Maternal cardiac deaths have increased over the past 30 years.
- Rising incidence is linked to older maternal age and increased cardiovascular risk factors (hypertension, diabetes, obesity).
Purpose of the Study:
- To review the management of cardiac disease in pregnant women.
- To highlight the increasing prevalence of acquired and congenital heart disease in childbearing women.
- To outline strategies for optimizing maternal cardiovascular health during pregnancy, delivery, and postpartum.
Main Methods:
- Review of data from the Centre for Maternal and Child Enquiries.
- Analysis of trends in maternal cardiac mortality.
- Discussion of physiological cardiovascular changes during pregnancy.
- Consideration of medication management in pregnancy.
Main Results:
- A steady increase in maternal deaths due to cardiac disease over three decades.
- Growing numbers of women of childbearing age with both acquired and congenital heart conditions.
- Recognition of significant cardiovascular adaptations during pregnancy impacting medical management.
Conclusions:
- Effective management requires optimizing maternal condition and monitoring for deterioration.
- Minimizing cardiovascular load during pregnancy, delivery, and postpartum is crucial.
- Addressing risk factors and adapting treatment are essential for improving outcomes.
Abstract:
Cardiac disease remains the leading cause of maternal death in the UK, and data from the Centre for Maternal and Child Enquiries have shown that the numbers of women dying from cardiac disease have steadily increased over the past 30 years. The incidence of acquired heart disease is increasing because of older age at first pregnancy, as well as a higher prevalence of cardiovascular risk factors, such as hypertension, diabetes and obesity. The number of women with congenital heart disease who are of childbearing age is also increasing. Significant cardiovascular changes occur in pregnancy even from an early gestation. This can affect the types and doses of medications used in pregnancy. The main aims of management are to optimise the mother's condition during pregnancy, to monitor for deterioration, and to minimise any additional load on the cardiovascular system from pregnancy, delivery and the postpartum period.
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