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Author Spotlight: Enhancing the Offspring Health in Rats with Maternal Exercise During Pregnancy
Published on: April 5, 2024
Pregnancy and cardiovascular disease
Karishma P Ramlakhan1, Mark R Johnson2, Jolien W Roos-Hesselink3
1Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands.
Insights
Cardiovascular disease in pregnancy is a leading cause of maternal death, particularly acquired conditions. Rising prevalence necessitates understanding its complex impact on both mother and fetus.
Area of Science:
- Cardiology
- Maternal-Fetal Medicine
- Obstetrics
Background:
- Cardiovascular disease (CVD) complicates 1-4% of pregnancies, a leading cause of maternal mortality.
- Acquired heart disease presenting during pregnancy has a high mortality rate.
- Increasing prevalence of CVD in pregnancy is linked to rising rates of obesity, diabetes, hypertension, and older maternal age.
Purpose of the Study:
- To review the physiological adaptations during pregnancy that can provoke or exacerbate cardiometabolic complications.
- To examine how cardiometabolic disease compromises pregnancy adaptations and fetal development.
- To highlight the challenges in managing CVD in pregnancy due to maternal physiological changes and fetal considerations.
Main Methods:
- Literature review of cardiovascular disease in pregnancy.
- Analysis of physiological changes during pregnancy and their impact on cardiometabolic health.
- Examination of the interplay between maternal cardiometabolic disease and fetal outcomes.
Main Results:
- Pregnancy involves profound physiological changes that can unmask or worsen cardiometabolic conditions.
- Cardiometabolic diseases pose risks to both maternal and fetal well-being.
- Management requires balancing essential treatment with potential fetal harm.
Conclusions:
- Cardiovascular disease in pregnancy presents significant challenges due to complex maternal physiology and fetal risks.
- Understanding the bidirectional impact of CVD and pregnancy adaptations is crucial for improved outcomes.
- Timely intervention and careful management are essential for mother and child survival.
Abstract:
Cardiovascular disease complicates 1-4% of pregnancies - with a higher prevalence when including hypertensive disorders - and is the leading cause of maternal death. In women with known cardiovascular pathology, such as congenital heart disease, timely counselling is possible and the outcome is fairly good. By contrast, maternal mortality is high in women with acquired heart disease that presents during pregnancy (such as acute coronary syndrome or aortic dissection). Worryingly, the prevalence of acquired cardiovascular disease during pregnancy is rising as older maternal age, obesity, diabetes mellitus and hypertension become more common in the pregnant population. Management of cardiovascular disease in pregnancy is challenging owing to the unique maternal physiology, characterized by profound changes to multiple organ systems. The presence of the fetus compounds the situation because both the cardiometabolic disease and its management might adversely affect the fetus. Equally, avoiding essential treatment because of potential fetal harm risks a poor outcome for both mother and child. In this Review, we examine how the physiological adaptations during pregnancy can provoke cardiometabolic complications or exacerbate existing cardiometabolic disease and, conversely, how cardiometabolic disease can compromise the adaptations to pregnancy and their intended purpose: the development and growth of the fetus.
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