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Cardiovascular Disease in Pregnancy
Cardiovascular disease remains a major contributor to rising maternal morbidity and mortality. Both the pregnant woman and fetus are exposed to many potential complications as a result of the physiologic changes of pregnancy. These changes can exacerbate existing cardiac disease, as well as lead to the development of de novo issues during gestation, delivery, and the postnatal period. For women with preexisting cardiac disease, including congenital malformations, valvular disease, coronary artery disease, and aortopathies, it is crucial that they receive multidisciplinary evaluation, counseling, and optimization before conception, as well as close monitoring and medication management during pregnancy. Close monitoring is also essential for patients who develop cardiovascular complications such as preeclampsia, cardiomyopathy, congestive heart failure, coronary events, and arrhythmias during pregnancy. In addition, concerning disparities in maternal morbidity and mortality exist across many dimensions, in part because of the lack of uniformity of care in different treatment settings. Establishment of multidisciplinary cardio-obstetric teams including representatives from cardiology, anesthesia, obstetrics, maternal-fetal medicine, and specialized nursing has proven instrumental to delivering evidence-based and equitable care to high-risk patients. Multidisciplinary teams should work to guide these patients through the preconception, antepartum, delivery, and postpartum phases to ensure appropriate care for weeks to years after pregnancy.
Education Gaps
- The best management approach for timing and mode of delivery for pregnant women with cardiovascular disease needs to be understood.
- Optimal fetal surveillance interval and modality in women with cardiovascular disease is still being understood.
- Pregnancy may have some long-term effects on specific cardiovascular conditions.
Objectives
After completing this article, readers should be able to:
- Explain maternal cardiac physiology in pregnancy.
- Describe specific cardiac conditions and how they are affected by pregnancy.
- Review the effects of maternal cardiac disease on the fetus.
- Recognize the importance of multidisciplinary care in caring for pregnant women with cardiovascular disease.
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