Related Experiment Video
Updated: Jul 17, 2025
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Cardio-Obstetrics and Heart Failure: JACC: Heart Failure State-of-the-Art Review
Ersilia M DeFilippis1, Catriona Bhagra2, Jillian Casale3
1Division of Cardiology, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA.
Insights
Managing heart failure and cardiomyopathy in pregnancy is vital. This review covers preconception counseling, risk stratification, medication safety, and advanced heart failure management for improved maternal and fetal outcomes.
Area of Science:
- Cardiology
- Obstetrics
- Maternal-Fetal Medicine
Background:
- Heart failure and cardiomyopathy contribute significantly to pregnancy-related deaths.
- Maternal morbidity and mortality rates associated with cardiovascular conditions are rising.
- Multidisciplinary cardio-obstetrics teams are essential for optimizing outcomes.
Purpose of the Study:
- To review preconception counseling for pregnant individuals with heart conditions.
- To discuss risk stratification and management of heart failure during pregnancy and postpartum.
- To address safety of heart failure medications and management of advanced heart failure in pregnancy.
Main Methods:
- Literature review of existing studies and guidelines.
- Synthesis of current knowledge on cardio-obstetrics.
- Discussion of unique management considerations for specific patient populations.
Main Results:
- Peripartum cardiomyopathy is common, but pregnancy can unmask pre-existing conditions.
- Specific management strategies are needed for pregnant women with heart failure.
- Safety profiles of heart failure medications during pregnancy and lactation require careful consideration.
Conclusions:
- Optimizing care for pregnant individuals with heart failure requires a comprehensive, multidisciplinary approach.
- Preconception counseling and risk stratification are key to improving maternal and fetal outcomes.
- Management strategies must extend through the postpartum period and address advanced cardiac conditions.
Abstract:
Heart failure and cardiomyopathy are significant contributors to pregnancy-related deaths, as maternal morbidity and mortality have been increasing over time. In this setting, the role of the multidisciplinary cardio-obstetrics team is crucial to optimizing maternal, obstetrical and fetal outcomes. Although peripartum cardiomyopathy is the most common cardiomyopathy experienced by pregnant individuals, the hemodynamic changes of pregnancy may unmask a pre-existing cardiomyopathy leading to clinical decompensation. Additionally, there are unique management considerations for women with pre-existing cardiomyopathy as well as for those women with advanced heart failure who may be on left ventricular assist device support or have undergone heart transplantation. The purpose of this review is to discuss: 1) preconception counseling; 2) risk stratification and management strategies for pregnant women extending to the postpartum "fourth trimester" with pre-existing heart failure or "pre-heart failure;" 3) the safety of heart failure medications during pregnancy and lactation; and 4) management of pregnancy for women on left ventricular assist device support or after heart transplantation.
