Pregnancy in Women With Diabetes and Ischaemic Heart Disease

Bagg, Warwick; Henley, Patrick; MacPherson, Paul; Cundy, Tim

doi:10.1111/j.1479-828x.1999.tb03454.x

Cited by 19 publications

(11 citation statements)

References 17 publications

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“…In this case, it is difficult to differentiate whether this event occurred secondary to the haemodynamic stress of pregnancy or was simply a manifestation of the natural history of LV dysfunction. Compared with earlier studies,7 8 maternal mortality was significantly lower in this study. A number of factors may explain this.…”

Section: Discussioncontrasting

confidence: 92%

“…Ischaemic cardiac events, such as acute myocardial infarction (MI) have been associated with high maternal and fetal mortality 4–6. While early case reports on pregnancy risk in women with pre-existing coronary artery disease (CAD) reported high maternal mortality,7 subsequent case series reported improved maternal outcomes 8 9. While many women with pre-existing CAD or a history of acute coronary syndrome (ACS) will consider pregnancy, the pregnancy risk for these women is not defined.…”

mentioning

confidence: 99%

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Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome

Burchill

Lameijer

Roos‐Hesselink

et al. 2015

Heart

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Objective The objective of this study was to determine outcomes in pregnant women with pre-existing coronary artery disease (CAD) or following an acute coronary syndrome (ACS) including myocardial infarction (MI). Background The physiological changes of pregnancy can contribute to myocardial ischaemia. The pregnancy risk for women with pre-established CAD or a history of ACS/MI is not well studied. Methods This was a retrospective multicentre study. Adverse maternal cardiac, obstetric and fetal/neonatal events were examined. The primary outcome was a composite endpoint of cardiac arrest, ACS/MI, ventricular arrhythmia or congestive heart failure. The prevalence of new or progressive angina during pregnancy was also examined. Results Fifty pregnancies in 43 women (mean age 35 ±5 years) were included. Coronary atherosclerosis (40%) and coronary thrombus (36%) were the most common underlying diagnoses. The primary outcome occurred in 10% (5/50) of pregnancies and included one maternal death secondary to cardiac arrest. Other events included ACS/MI (3/50) and heart failure (1/50). New or progressive angina occurred in 18% of pregnancies. Ischaemic complications of any type (new or progressive angina, ACS/MI, ventricular arrhythmia, cardiac arrest) occurred more commonly in women with coronary atherosclerosis compared with those without (50% vs 10%, p=0.003). A high rate of adverse obstetric (16%) and fetal/neonatal (30%) events was observed. Conclusions Pregnant women with pre-existing CAD or ACS/MI before pregnancy are at increased risk of adverse events during pregnancy. Those with coronary atherosclerosis are at highest risk of adverse maternal cardiac events due to myocardial ischaemia during pregnancy.Current trends have led to an older age at the time of childbirth and increases in the prevalence of maternal diabetes, obesity and hypertension. These factors have contributed to a rising number of women of childbearing age with pre-existing coronary disease.1-3 Ischaemic cardiac events, such as acute myocardial infarction (MI) have been associated with high maternal and fetal mortality. [4][5][6] While early case reports on pregnancy risk in women with pre-existing coronary artery disease (CAD) reported high maternal mortality, 7 subsequent case series reported improved maternal outcomes.8 9 While many women with pre-existing CAD or a history of acute coronary syndrome (ACS) will consider pregnancy, the pregnancy risk for these women is not defined. The objective of this study was to determine maternal and fetal/neonatal outcomes in a large contemporary group of pregnant women with a history of CAD or ACS/MI prior to pregnancy. METHODS Study populationThis was a multicentre review of pregnancies in women seen between 1995 and 2012 at one of the participating centres (University of Toronto, Toronto, Canada; University of British Columbia, Vancouver, Canada; Erasmus University, Rotterdam, The Netherlands; University Medical Centre, Groningen, The Netherlands; Academic Medical Center, Amsterdam, The Netherl...

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Section: Discussioncontrasting

confidence: 92%

mentioning

confidence: 99%

Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome

Burchill

Lameijer

Roos‐Hesselink

et al. 2015

Heart

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“…Although rare, cardiovascular disease (CVD) can occur in women of reproductive age with diabetes. Myocardial infarct (MI) in pregnancy is associated with poor maternal and fetal outcomes (71,72). Women with known CVD should be evaluated and counselled about the significant risks associated with pregnancy.…”

Section: Assessment and Management Of Complicationsmentioning

confidence: 99%

Diabetes and Pregnancy

Feig¹,

Berger²,

Donovan³

et al. 2018

Canadian Journal of Diabetes

249

169

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All women with pre-existing type 1 or type 2 diabetes should receive preconception care to optimize glycemic control, assess for complications, review medications and begin folic acid supplementation.• All pregnant women without known pre-existing diabetes should be screened for gestational diabetes between 24 to 28 weeks of pregnancy • If you were diagnosed with gestational diabetes during your pregnancy, it is important to:• Breastfeed immediately after birth and for a minimum of 4 months in order to prevent hypoglycemia in your newborn, obesity in childhood, and diabetes for both you and your childConflict of interest statements can be found on page S274.Can J Diabetes 42 (2018) S255-S282

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“…There is an increased risk of mortality in women who have diabetes and documented ischemic heart disease, 37 and such women should be referred for assessment by a cardiologist. They need to be counseled sensitively about the increased maternal risk with pregnancy.…”

Section: Cardiovascular D Isease and H Ypertensionmentioning

confidence: 99%

Prepregnancy Care for Type 1 and Type 2 Diabetes

Temple

2010

A Practical Manual of Diabetes in Pregnancy

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Pregnancy in Women With Diabetes and Ischaemic Heart Disease

Cited by 19 publications

References 17 publications

Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome

Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome

Diabetes and Pregnancy

Prepregnancy Care for Type 1 and Type 2 Diabetes

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