Poorly Understood Maternal Risks of Pregnancy in Women With Heart Disease
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One of the most significant accomplishments of modern medicine worldwide is the dramatic 28% decrease in neonatal mortality during the past 20 years. However, although neonatal survival is improving and, for most of the world, maternal mortality is decreasing, this trend has not been seen in the United States. Neonatal survival has improved in the United States, whereas maternal mortality has increased from 7.2 deaths per 100 000 in 1989 to 17 deaths per 100 000 in 2013. In fact, the United States is the only developed nation with a rising maternal mortality rate. Maternal mortality is even higher for black women, approaching 4-fold that of their white, Asian, or Hispanic counterparts. Although cardiac disease complicates a small number of all pregnancies, it has become a leading cause of maternal morbidity and mortality, surpassing both hemorrhage and embolic events. Understanding the causes of this worrisome trend must become a research priority with plans to develop novel interventions to improve maternal outcomes, particularly as the birthrate in women >35 years of age and the associated comorbidities that go along with advanced maternal age continue to increase.
Before the widespread institution of penicillin, rheumatic heart disease was the most common form of heart disease encountered in pregnancy. Marked improvements in treating congenital heart disease have led to more women with congenital cardiac malformations reaching reproductive age and …