Cardiovascular Disease in Pregnancy
Cardiovascular disease is the leading cause of death generally and the most common cause of death during pregnancy in industrialized countries. Improvement in early diagnosis and treatment of congenital heart disease has increased the number of women with such conditions reaching reproductive age. The growing prevalence of diabetes, hypertension, obesity, hyperlipidemia, and metabolic syndrome has concurrently added to the population of pregnant women with acquired heart disease, including coronary artery disease. Physiologic changes occurring during pregnancy can stress a compromised cardiovascular system, resulting in maternal morbidity, mortality, and compromised fetal outcomes. These risks complicate affected women's decisions to become pregnant, their ability to carry a pregnancy to term, and the complexity and risk benefit of cardiovascular treatments delivered during pregnancy. Risk assessment indices assist the obstetrician, cardiologist, and primary care provider in determining the general prognosis of the patient during pregnancy and although imperfect, can aid patients in making informed decisions. Treatments must be selected that ideally benefit the health of both mother and fetus and at a minimum limit risk to the fetus during gestation.
Reducing maternal mortality remains a major healthcare focus worldwide. The Fifth Millennium Development Goal, embraced in 1990, was intended to lower the maternal mortality rate to 75% by 2015. Maternal mortality has decreased by 47% during the past 20 years, with improved prenatal and obstetric care for sepsis and hemorrhage; however, pregnancy-associated deaths have become more frequent in the United States (also Canada and Norway) in recent years based on numerical estimates exclusive of patients with new diseases (eg, human immunodeficiency virus infection). The United States has a higher maternal death rate than at least 40 other countries.
Cardiovascular disease (CVD) is the leading cause of pregnancy-associated maternal mortality, defined as death occurring between conception and postpartum day 42. Improved survival of future mothers with congenital heart disease (CHD), older maternal age, and increasing incidence of atherosclerosis during the childbearing years have created a new and growing cohort of patients who are less able to tolerate the hormonal and hemodynamic stresses of pregnancy. A woman's decision to become pregnant or carry a pregnancy to term requires prognostic information and plans for careful management from healthcare providers.
Pregnancy-related deaths can be divided into two distinct categories: direct deaths (resulting from obstetrical complications) and indirect deaths (resulting from previous existing disease or disease that developed during pregnancy). CVDs, cardiomyopathy, hypertensive disorders, and pulmonary embolism are the most common indirect causes of maternal death. This article reviews CVD in pregnancy, epidemiology, risk assessment, and clinical management of specific high-risk conditions.
Abstract and Introduction
Abstract
Cardiovascular disease is the leading cause of death generally and the most common cause of death during pregnancy in industrialized countries. Improvement in early diagnosis and treatment of congenital heart disease has increased the number of women with such conditions reaching reproductive age. The growing prevalence of diabetes, hypertension, obesity, hyperlipidemia, and metabolic syndrome has concurrently added to the population of pregnant women with acquired heart disease, including coronary artery disease. Physiologic changes occurring during pregnancy can stress a compromised cardiovascular system, resulting in maternal morbidity, mortality, and compromised fetal outcomes. These risks complicate affected women's decisions to become pregnant, their ability to carry a pregnancy to term, and the complexity and risk benefit of cardiovascular treatments delivered during pregnancy. Risk assessment indices assist the obstetrician, cardiologist, and primary care provider in determining the general prognosis of the patient during pregnancy and although imperfect, can aid patients in making informed decisions. Treatments must be selected that ideally benefit the health of both mother and fetus and at a minimum limit risk to the fetus during gestation.
Introduction
Reducing maternal mortality remains a major healthcare focus worldwide. The Fifth Millennium Development Goal, embraced in 1990, was intended to lower the maternal mortality rate to 75% by 2015. Maternal mortality has decreased by 47% during the past 20 years, with improved prenatal and obstetric care for sepsis and hemorrhage; however, pregnancy-associated deaths have become more frequent in the United States (also Canada and Norway) in recent years based on numerical estimates exclusive of patients with new diseases (eg, human immunodeficiency virus infection). The United States has a higher maternal death rate than at least 40 other countries.
Cardiovascular disease (CVD) is the leading cause of pregnancy-associated maternal mortality, defined as death occurring between conception and postpartum day 42. Improved survival of future mothers with congenital heart disease (CHD), older maternal age, and increasing incidence of atherosclerosis during the childbearing years have created a new and growing cohort of patients who are less able to tolerate the hormonal and hemodynamic stresses of pregnancy. A woman's decision to become pregnant or carry a pregnancy to term requires prognostic information and plans for careful management from healthcare providers.
Pregnancy-related deaths can be divided into two distinct categories: direct deaths (resulting from obstetrical complications) and indirect deaths (resulting from previous existing disease or disease that developed during pregnancy). CVDs, cardiomyopathy, hypertensive disorders, and pulmonary embolism are the most common indirect causes of maternal death. This article reviews CVD in pregnancy, epidemiology, risk assessment, and clinical management of specific high-risk conditions.
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