Nearly 4 million women give birth in the United States annually. The majority of these women tolerate the physiological changes of pregnancy without incident. The hemodynamic changes, which are largely mediated by hormonal changes, may not be well-tolerated by women with complicated congenital and genetic heart disease as well as those with advanced hypertension, cardiomyopathies, or significant valve disorders. Knowledge of how pregnancy-associated physiological changes intersect with these disorders is paramount in the care of these patients.
Most women begin pregnancy without preexisting cardiovascular conditions, but some of them develop hypertension with or without preeclampsia/eclampsia. Effective therapy is important for the successful pregnancy outcome of these women and their offspring. More recently, it has been recognized that the presence of cardiovascular risk factors during pregnancy, such as hypertension and diabetes mellitus, influence the development of cardiovascular disease in later life. Research into the long-term health effects of pregnancy on mothers and their children is an evolving area of interest.
Cardiovascular disorders such as myocardial infarction and cardiomyopathy develop in a small proportion of women during pregnancy or early postpartum. The causes of these disorders include coronary artery dissection and peripartum cardiomyopathy, distinctly different from the usual causes of these problems seen in older patients. These disorders can influence the incident pregnancy and alter maternal risk in subsequent pregnancies.
In this Circulation Series on Cardiovascular Management in Pregnancy, a group of experts has reviewed topics ranging from the physiology of pregnancy, management of pregnancy in patients with a variety of preexisting (adult congenital heart disease) and de novo (hypertension, myocardial infarction, cardiomyopathy) diseases, to the impact of pregnancy on long-term maternal and fetal outcomes. Knowledge of these disorders in pregnancy, safety of pharmacological therapies, and the long-term impact of these conditions on maternal and fetal outcome is important for both obstetric and cardiology providers caring for these patients.
Sharon Reimold, MD
- © 2014 American Heart Association, Inc.