Top Things to Know: CV Considerations in Caring for Pregnant Patients
Published: May 04, 2020
- Cardiovascular disease (CVD) is now the primary cause of pregnancy-related mortality in the US, resulting in 7.2 deaths per 100,000 live births in 2015.
- Advanced age and pre-existing co-morbid conditions such as diabetes, hypertension and congenital heart disease, have contributed to the increased rates of maternal mortality.
- Preconception counseling and the early involvement of a multidisciplinary cardio-obstetrics team is needed to assess comprehensively maternal and fetal risks associated with pregnancy.
- Hypertension during pregnancy should be treated and monitored aggressively with careful follow up postpartum.
- Ischemic heart disease during pregnancy is rare but a potentially fatal condition with a 3- to 4-fold higher risk of acute myocardial infarction in pregnant women compared to non-pregnant women.
- Peripartum cardiomyopathy (PPCM), defined as new onset cardiomyopathy with systolic dysfunction (left ventricular ejection fraction < 45%) without a reversible cause, is a significant cause of maternal morbidity and mortality.
- Pregnancy in women with mechanical prosthetic heart valves is associated with increased risk of fetal and maternal morbidity and mortality. The optimal strategy for maintenance of anticoagulation during pregnancy in women with prosthetic heart valves varies.
- Cerebrovascular diseases are the highest in the 3rd trimester and within 6 weeks postpartum, including ischemic stroke, intracerebral hemorrhage, cerebral venous thrombosis, reversible cerebral vasoconstriction syndrome, and posterior reversible encephalopathy syndrome.
- Postpartum monitoring is essential in patients with pre-existing or new heart failure, significant arrhythmia, severe valve disease, aortopathy or recent myocardial infarction. These high-risk patients will require specialized long-term cardiovascular follow-up.
- Adverse pregnancy outcomes are associated with increased risk of future CVD (hypertension, ischemic heart disease, stroke) adverse events and are now included in the 2018 AHA/ACC Cholesterol Guidelines as cardiovascular risk-enhancing conditions. These patients warrant education about their risk, long term follow-up, and aggressive risk factor modification.
Citation
Mehta LS, Warnes CA, Bradley E, Burton T, Economy K, Mehran R, Safdar B, Sharma G, Wood M, Valente AM, Volgman AS; on behalf of the American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; and Stroke Council. Cardiovascular considerations in caring for pregnant patients: a scientific statement from the American Heart Association [published online ahead of print May 4, 2020]. Circulation. doi: 10.1161/CIR.0000000000000772.