Pregnancy and Cardiovascular Disease

Abstract

The cardiovascular system undergoes significant changes during pregnancy to adapt to and accommodate the increased metabolic demands of the fetus and the mother. These adaptations produce an important hemodynamic burden on patients with underlying heart disease, and confer an increase in morbidity and mortality. Furthermore, pregnancy may cause specific cardiovascular disorders, which can impose a risk to the pregnant woman and to her fetus. It is estimated that in the western world 0.2-4% of all pregnancies are complicated by cardiovascular diseases (CVD). This risk is in the ascending order as the age of first pregnancy is increasing and as the number of cardiovascular risk factors is rising (e.g. smoking, hypercholesterolemia, diabetes, hypertension, obesity). During pregnancy, the most frequent cardiovascular events relate to hypertension (6–8%). On the other hand, in the western world, the most frequent CVD present during pregnancy is congenital heart disease-CHD (circa 75%), while rheumatic heart disease predominates in the other countries (circa 70%) and CHD is seen in ~15%. In pregnant women with heart disease, maternal death is estimated around 1% but it varies depending on the underlying CVD; neonatal complications occur in 20–28% and neonatal mortality ranges between 1% and 4%. In general, CVDs are the most common cause of maternal death during pregnancy in the Western industrialized world.⁴ Thus, women of child-bearing age with CVD or cardiovascular risk factors should be counseled and managed early by an interdisciplinary team of gynecologists, cardiologists, and, when necessary, cardiothoracic surgeons... (excerpt)