Cardiac Disease in Pregnancy

Introduction

Pregnancy places significant physiological stress on a woman's body, especially the cardiovascular system. For women with pre-existing heart disease or newly diagnosed cardiac conditions, pregnancy can increase the risk of complications for both the mother and the fetus. Understanding these risks and managing them appropriately is essential for a safe pregnancy and delivery.

Physiological Changes in Pregnancy

During pregnancy, several changes occur in the cardiovascular system:

• Increased blood volume: Blood volume increases by 30-50%, leading to higher cardiac output.
• Heart rate elevation: The heart rate rises by 10-20 beats per minute.
• Reduced systemic vascular resistance: To accommodate increased blood flow, blood vessels dilate, reducing blood pressure in some cases.
• Increased oxygen demand: The heart works harder to supply oxygen to the growing fetus.

Types of Cardiac Disease in Pregnancy

1. Congenital Heart Disease: Women born with heart defects who have undergone surgery may still face risks in pregnancy.
2. Valvular Heart Disease: Conditions such as mitral stenosis or aortic stenosis can worsen due to increased blood flow.
3. Cardiomyopathies: Peripartum cardiomyopathy is a condition that can occur in late pregnancy or postpartum, leading to heart failure.
4. Hypertensive Disorders: Conditions such as preeclampsia or chronic hypertension can lead to complications.
5. Coronary Artery Disease: Though rare in young women, some may develop pregnancy-related ischemic heart disease.

Risks to Mother and Baby

Maternal Risks:

• Heart failure due to volume overload
• Arrhythmias
• Thromboembolism, especially in those with mechanical heart valves
• Increased risk of stroke

Fetal Risks:

• Preterm birth
• Intrauterine growth restriction (IUGR)
• Low birth weight
• Increased risk of congenital heart disease in offspring

Diagnosis and Monitoring

• Echocardiography to assess heart function
• Electrocardiogram (ECG) to detect arrhythmias
• Cardiac MRI if needed (avoiding contrast agents when possible)
• Regular obstetric and cardiology follow-ups

Management Strategies

• Multidisciplinary Approach: Close collaboration between cardiologists, obstetricians, and anesthesiologists.
• Medications: Adjustments must be made to avoid harmful drugs during pregnancy (e.g., avoid ACE inhibitors, warfarin in certain cases).
• Lifestyle Modifications: Salt restriction, avoiding excessive exertion.
• Mode of Delivery: Vaginal birth is often preferred, but cesarean section may be necessary for high-risk cases.

Conclusion

Women with cardiac disease can have successful pregnancies with proper planning and management. Preconception counseling, risk assessment, and continuous monitoring are crucial for optimizing outcomes for both the mother and baby.

Source recommendations

1. American Heart Association Guidelines on Cardiovascular Disease in Pregnancy

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000772
2. https://www.heart.org/en/news/2023/02/13/to-improve-maternal-health-report-says-to-start-before-pregnancy
3. https://newsroom.heart.org/news/aha-statement-pregnant-women-with-cvd-need-specialized-care-before-during-and-postpartum
4. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001121

2. European Society of Cardiology Guidelines on the Management of Cardiovascular Disease during Pregnancy

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiovascular-Diseases-during-Pregnancy-Management-of
2. https://pubmed.ncbi.nlm.nih.gov/30165544/
3. https://www.escardio.org/static-file/Escardio/Guidelines/publications/PREGN%20Guidelines-Pregnancy-FT.pdf
4. https://pubmed.ncbi.nlm.nih.gov/21873418/
5. https://academic.oup.com/eurheartj/article/39/34/3165/5078465