Cardiovascular Complications in Pregnancy: It Is Time for Action.

Abstract

Cardiovascular disease (CVD) is the leading cause of death during pregnancy, accounting for ≈33% of the maternal deaths in the United States.1 There is also increasing evidence that there is a significant link between complications of pregnancy and CVD later in life. Pregnancy complications such as preeclampsia, gestational diabetes mellitus, gestational hypertension, preterm delivery, and delivery of an infant with growth restriction provide signals about the mother’s cardiovascular adaptability of physiological stress. It is time to change the paradigm for identifying and preventing CVD in women. Despite advances in medical technology and knowledge, maternal morality during pregnancy has continued to increase over the past 3 decades. According to the Centers for Disease Control, maternal deaths per 100 000 live births have increased from 7.2% in 1987 to 17.3% in 2013. Up to a quarter of these deaths were thought to be preventable. Data from the California Pregnancy Associated Mortality Review reported many women did not know that they had cardiovascular issues prior to pregnancy and, although many of them presented with cardiac symptoms during pregnancy or in the immediate postpartum period, the diagnosis of CVD was often delayed or ignored.2 Many of the cardiovascular complications during pregnancy were the result of acquired conditions. The adult survivors of congenital heart disease are another rapidly growing, high-risk …