Heart Disease in Pregnancy

Abstract

Cardiovascular disease (CVD) in pregnancy includes congenital heart disease, acquired heart disease, and myocardial diseases. Although CVD affects only 1–4% of pregnancies in the United States, maternal CVD is the major cause of nonobstetric maternal mortality. Hypertensive disorders occur in 6–8% of all pregnancies and contribute to CVD in pregnancy. Advancing maternal age has increased the incidence of acquired heart disease complicating pregnancy. Congenital heart disease is now the most common form of CVD seen in pregnancy in the United States and Western Europe, accounting for about 80% of CVD cases and 20% of maternal deaths. In developing countries, rheumatic heart disease remains the most common cause (60–90%) of CVD in pregnancy. The hemodynamic adaptations of the maternal cardiovascular system to pregnancy and labor and delivery increase the pregnancy-associated risks in women with preexisting cardiomyopathy, arrhythmia, aortopathy, and valvular and congenital heart disease. Hypertension in pregnancy and peripartum cardiomyopathy are acquired disorders related to pregnancy. Proper risk assessment, prepregnancy counseling, and management of pregnancy in women with preexisting and acquired cardiovascular disease are best performed with a multidisciplinary team.