Cardiac Disease in Pregnancy

Maternal morbidity and mortality secondary to heart disease in pregnancy is increasing (Silversides CK et al., J Am Coll Cardiol. 71:2419–2430, 2018; Roos-Hesselink J et al., Eur Heart J. 40:3848, 2019). In the United States, cardiac disease is now the leading cause of pregnancy-related mortality (CDC. Pregnancy mortality surveillance system. 2022. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm . Accessed 22 Feb 2023). Chronic medical conditions such as diabetes mellitus, hypertension, and obesity in addition to increasing maternal age are likely contributing factors to this trend (CDC. Pregnancy mortality surveillance system. 2022. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm . Accessed 22 Feb 2023). Patients with congenital heart disease (CHD) are now surviving to reproductive age and presenting with pregnancy. Between 2000 and 2010, the prevalence of congenital heart disease in pregnant patients increased from 6.4 to 9.0 per 10,000 delivery hospitalizations (Thompson JL et al., Obstetrics Gynecol. 126:346–354, 2015). In a prospective study of 5739 pregnant patients with CHD (57%) and valvular heart disease (29%) enrolled in the Registry Of Pregnancy and Cardiac disease (ROPAC), the proportion of patients with high-risk pregnancies (modified World Health Organization Class IV) increased from 0.7% in 2007–2010 to 10.9% in 2015–2018 (Roos-Hesselink J et al., Eur Heart J. 40:3848, 2019). Over this same period, complication rates fell from 13.2 to 9.3% (Roos-Hesselink J et al., Eur Heart J. 40:3848, 2019). Early cardio-obstetric multidisciplinary collaboration in the antepartum period is essential for peripartum planning and postpartum management to optimize maternal and fetal outcomes (Mehta LS et al., Circulation. 141:e884–e903, 2020). Cardio-obstetric team members include obstetricians, cardiologists, anesthesiologists, maternal-fetal medicine physicians, and other subspecialty physicians such as interventional cardiologists or cardiothoracic surgeons (American College of Obstetricians and Gynecologists’ Presidential Task Force on Pregnancy and Heart Disease and Committee on Practice Bulletins—Obstetrics, Obstet Gynecol. 133:e320–e356, 2019).