Heart Disease and Pregnancy: The Need for a Twenty-First Century Approach to Care…

Abstract

Pregnancy and childbirth present a specific challenge to the maternal cardiovascular system. Pre-existing cardiac diseases, or cardiac diseases that occur during pregnancy, are associated with a significant risk of morbidity and mortality for both mother and baby. In recent decades, cardiac disease has emerged as a leading cause of maternal death in most high income countries, including Australia and New Zealand. The burden of cardiac disease in pregnancy is likely to be growing due to an increase in adult survivors with congenital heart disease embarking on pregnancy coupled with demographic shifts in the age and cardiovascular risk factors of women giving birth and the persisting high incidence of acute rheumatic fever in First Nations women. There is widespread consensus that the best obstetric and neonatal outcomes in women with cardiac disease are delivered by a strategy of carefully coordinated multidisciplinary care. Australia and New Zealand currently lack nationally agreed strategies for clinical practice and service delivery for women with heart disease in pregnancy. This state-of-the-art review summarises some of the key issues faced in relation to prevention, diagnosis, treatment and health service delivery in this patient group and concludes with suggested priorities for policy and research.

The association between guidelines adherence and clinical outcomes during pregnancy in a cohort of women with cardiac co-morbidities

“…Cardiovascular disease is a major cause of maternal mortality, accounting for up to 15% of maternal deaths and complicating between 1% and 4% of pregnancies, with the associated morbidities becoming an increasingly recognised issue, warranting our attention [1][2][3][4]. However, limited data is available on cardiac disease in pregnancy in Australia, and research is underreported [5,6]. The national maternal mortality ratio, i.e.…”

“…The national maternal mortality ratio, i.e. the number of deaths per 100, 000 women giving birth, was reportedly below ten from 2008 to 2017 [6,7]. Yet cardiac-related maternal deaths occurring during pregnancy are classified as indirect maternal deaths due to preexistent medical conditions or disease acquired during pregnancy rather than the consequence of direct obstetric death [5].…”

“…Yet cardiac-related maternal deaths occurring during pregnancy are classified as indirect maternal deaths due to preexistent medical conditions or disease acquired during pregnancy rather than the consequence of direct obstetric death [5]. Heart disease in pregnancy consists of a heterogeneous group of disorders inclusive of corrected and uncorrected congenital lesions, valvular disease, arrhythmias, aortopathies, cardiomyopathies, acquired atherosclerotic heart disease, genetic conditions, and cardiac complications associated with severe hypertensive disorders [6,8]. Due to the increased physiological stress of pregnancy on the maternal cardiovascular system, maternal preexisting or cardiac pathological conditions acquired during pregnancy may have different outcomes than those in the non-pregnant state [9].…”

Heart Disease in Women: Where Are We Now and What is The Future?

“…We also celebrate the expertise of Australian and New Zealand researchers within this expanding sub-specialty. The special edition contains 9 in-depth reviews [4,[6][7][8][9][10][11][12][13], and a further 16 original scientific papers covering a broad range of topics and selected from a competitive submission process [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The female-predominant condition of SCAD is covered in an insightful review [4], with detailed discussion on the commonly associated genetic condition of fibromuscular dysplasia.…”

“…Pregnancy places a unique stress on the female cardiovascular system with specific diagnostic and management challenges of heart disease in pregnancy, and the emergence of pregnancy-related novel CVD risk factors. Two in-depth reviews focus on pregnancy issues [7,8], with a further original papers covering topics from pre-conception counselling [20], management of congenital heart disease and transplant recipients during pregnancy [21], and the lack of awareness of pregnancy-related CVD risk factors [9,22].…”