Cardiovascular Pregnancy Complications Research Articles

Trends in cardiovascular complications of pregnancy: A nationwide inpatient sample analysis

BackgroundCardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the United States. Physiologic stress of pregnancy can induce several hemodynamic changes that contribute to an increased risk of cardiac complications in the peripartum period. There are ongoing efforts to improve cardiovascular mortality in pregnant patients. Understanding trends in cardiovascular complications during pregnancy may provide insight into improving care for high-risk pregnancies. MethodsWe retrospectively analyzed data from the National Inpatient Sample (NIS) Database and identified all inpatient hospitalizations for pregnancy and delivery. We then analyzed trends in the rates of cardiac complications in the pregnant patient. ResultsThere are concerning increases in trends of cardiac complications and comorbidities in pregnant people including: acute coronary syndrome, spontaneous coronary artery dissection, cardiogenic shock, pulmonary hypertension, chronic congestive heart failure, heart transplant, aortic syndromes, stroke, and pulmonary embolism. While the rates of STEMI have decreased, the incidence of peripartum cardiomyopathy has remained stable. ConclusionThere are concerning increases in certain cardiac complications during pregnancy. This is likely due to increasing age at the time of pregnancy and associated comorbidities.

Differential Outcomes for African-American Women with Cardiovascular Complications of Pregnancy

Maternal mortality is rising in the USA, and cardiovascular disease is the leading cause of death. Black women are 3 times more likely to die than White women as a result of pregnancy-related causes. In this review, we describe the differential outcomes of Black women with cardiovascular conditions related to pregnancy. Black women have a higher risk of developing peripartum cardiomyopathy (PPCM) and preeclampsia compared to White women. Black women with PPCM present with more severe disease and are less likely to experience myocardial recovery. Black women with preeclampsia are at higher risk of severe maternal morbidity and mortality compared to White women, regardless of socioeconomic status. The higher prevalence of chronic medical conditions among Black women do not fully explain the higher rates of adverse outcomes. Racial differences in outcomes for other cardiovascular conditions have not been well-described. Black women are at significantly higher risk of cardiovascular complications related to pregnancy. Interventions focused on access to care, quality of care, and social determinants of health before, during, and after pregnancy may improve maternal outcomes, especially for Black women in the USA.

Pregnancy outcomes in a patient with Fontan circulation for single ventricle congenital heart disease and aberrant praevia placental lobe

Single ventricle heart (SVH) is a very rare congenital heart disease. However, since the introduction of Fontan's intervention, the survival rate of patients with SVH has been significantly improved, increasing the number of women who may become pregnant in this condition. It has been already reported, in isolated case presentations or in some series of patients, that the pregnacy in the context of SVH and Fontan circulation carries a very high risk for first trimester miscarriage, maternal cardiovascular or obstetric complications and for an increased rate of pre-term birth. Therefore, it is an open field of debate weather or not to allow pregnancy in this category of patients. We are presenting the case of a 22 years old patient who underwent two surgeries for SVH: a Glenn procedure when she was 2 years old and the implantation of a Fontan circuit at the age of 16 years. Since the last surgery she was under permanent internal cardiac stimulation. During the pregnancy the patient was hemodynamically stable, with a normal resting oxygen saturation and a good ejection fraction of the single ventricle. However, the evolution of this patient has become even more challenging due to an aberrant praevia placental lobe. This condition brought her to hospital for several episodes of metrorrhagia and uterine contractions. She delivered at 33 weeks of gestation by emergency Caesarian section with a good evolution until discharge, for mother and the newborn. This case is supporting the opinion that pregnancy can be tolerated without important cardiovascular events in patients with SVH and Fontan circulation, unless heart failure or cardiac arrythmia are associated. Nevertheless, the obstetrical complications remain an important problem in pregnancy overcome of patients with Fontan circulation for SVH that can be superimposed with other unfavorable conditions, like aberrant praevia placental lobe in this case. During the management of such particular clinical settings difficult decisions must be taken, including those addressing the antithrombotic therapy that will be covered in the presentation of this case. Keywords: Pregnancy outcome; Cardiovascular pregnancy complications; Fontan procedure; Delivery, obstetrics.

Is plasminogen activator inhibitor-1 a physiological bottleneck bridging major depressive disorder and cardiovascular disease?

Major depressive disorder (MDD) is estimated to affect one in twenty people worldwide. MDD is highly comorbid with cardiovascular disease (CVD), itself one of the single largest causes of mortality worldwide. A number of pathological changes observed in MDD are believed to contribute to the development of cardiovascular disease, although no single mechanism has been identified. There are also no biological markers capable of predicting the future risk of developing heart disease in depressed individuals. Plasminogen activator inhibitor-1 (PAI-1) is a prothrombotic plasma protein secreted by endothelial tissue and has long been implicated in CVD. An expanding body of literature has recently implicated it in the pathogenesis of major depressive disorder as well. In this study, we review candidate pathways implicating MDD in CVD and consider how PAI-1 might act as a mediator by which MDD induces CVD development: chiefly through sleep disruption, adiposity, brain-derived neurotrophic factor (BDNF) metabolism, systemic inflammation and hypothalamic-pituitary-adrenal (HPA)-axis dysregulation. As both MDD and CVD are more prevalent in women than in men, and incidence of either condition is dramatically increased during reproductive milestones, we also explore hormonal and sex-specific associations between MDD, PAI-1 and CVD. Of special interest is the role PAI-1 plays in perinatal depression and in cardiovascular complications of pregnancy. Finally, we propose a theoretical model whereby PAI-1 might serve as a useful biomarker for CVD risk in those with depression, and as a potential target for future treatments.

Cardiovascular Complications of Pregnancy.

Pregnancy causes significant metabolic and hemodynamic changes in a woman’s physiology to allow for fetal growth. The inability to adapt to these changes might result in the development of hypertensive disorders of pregnancy (hypertension, preeclampsia or eclampsia), gestational diabetes and preterm birth. Contrary to previous beliefs these complications are not limited to the pregnancy period and may leave permanent vascular and metabolic damage. There is in addition, a direct association between these disorders and increased risk of future cardiovascular disease (CVD, including hypertension, ischemic heart disease, heart failure and stroke) and diabetes mellitus. Despite abundant evidence of this association, women who present with these complications of pregnancy do not receive adequate postpartum follow up and counseling regarding their increased risk of future CVD. The postpartum period in these women represents a unique opportunity to intervene with lifestyle modifications designed to reduce the development of premature cardiovascular complications. In some cases it allows early diagnosis and treatment of chronic hypertension or diabetes mellitus. The awareness of this relationship is growing in the medical community, especially among obstetricians and primary care physicians, who play a pivotal role in detecting these complications and assuring appropriate follow up.

The Cardiovascular Complications of Pregnancy

During the course of a normal pregnancy, the cardiovascular system of the mother is required to adapt to significant alterations in hemodynamics, including an almost 50% increase in cardiac output. This change in cardiac output is mediated by a significant increase in heart rate, a change in blood volume, as well as a neurohormonally mediated increase in vasodilatation. Simultaneously, significant changes occur in other organ systems, which also affect the cardiovascular system. For instance, there are increases in erythropoiesis to increase red cell mass, increased production of procoagulant factors, and profound activation of the collagenolytic system. To discuss the multitude of cardiovascular complications that can occur during pregnancy, we must understand the adaptations required in the cardiac, hematologic, and musculoskeletal systems. The purpose of this review is to delineate the adaptations required by each organ system and to review the complications that result when maternal physiology is unable to make the required adaptations.