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Video: Is Pregnancy Dangerous With Heart Disease?
Is pregnancy dangerous with heart disease?
Pregnancy is safe for most women with heart disease, but too risky for some. Research shows that fewer women with heart disease or heart failure die during pregnancy than ten years ago.
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Pregnancy for women with cardiovascular disease is relatively safe, according to a report presented at the final scientific session of the 2018 European Heart Society Congress in Munich. The results of this ten-year study are published in the European Heart Journal.
Professor Jolien Roos-Hesselink from Erasmus Medical Center, Rotterdam, The Netherlands, said:
“Pregnancy is safe for most women with heart disease, but too risky for some. Our research shows that fewer women with heart disease or heart failure die during pregnancy than ten years ago. However, almost one in ten women with pulmonary arterial hypertension died during pregnancy or in the early postpartum period.
Pre-pregnancy counseling is critical to identifying women who should not be advised to become pregnant, but should start early treatment, for example, for severe heart failure, and discuss risks and options. Pregnancy seriously affects the mother's circulation, as the heart must pump 50% more blood and the heart rate rises by 10-20%. This can be risky for women with heart disease.
Heart disease is the leading cause of female deaths during pregnancy in developed countries. Globally, cardiovascular disease causes up to 15% of maternal deaths during pregnancy or early postpartum. While other causes of maternal mortality (blood loss or infection) are declining, cardiovascular disease is on the rise.
The researchers analyzed the results of 5,739 pregnant women with cardiovascular disease from 138 centers in 53 countries between 2007 and 2018. The average age of mothers was 29.5 years, and 45% of them had never given birth before.
More than half of the women (57%) were born with heart failure (congenital heart disease), but most of them underwent surgery at a young age. Other diagnoses were heart disease (29%), cardiomyopathy (8%), aortic disease (4%), ischemic heart disease (2%), and pulmonary arterial hypertension (1%).
“The proportion of women at very high risk of the disease, according to the World Health Organization, increased from about 1% in 2007 to 10% in 2018. This suggests that women at high risk for cardiovascular disease are becoming pregnant more often than in the past. This is likely due to the fact that corrective surgery improves survival and women reach reproductive age, and perhaps doctors are becoming more selective about who is advised to avoid pregnancy,”explained Roos-Hesselink.
Overall, less than 1% of women died during pregnancy or early in the postpartum period. The highest mortality rate (9%) was found in women with pulmonary arterial hypertension - abnormally high blood pressure in the lungs. Fetal and newborn mortality rates were 1%.
44% of women gave birth by caesarean section, of which more than a third were for cardiac reasons (16% of all births). Among the complications noted were heart failure (11%), supraventricular (2%) and ventricular (2%) arrhythmias. Complications during pregnancy occurred more often if before pregnancy there was: ejection fraction) or the use of anticoagulants.
“After an initial increase in maternal mortality and new diagnoses of heart failure during pregnancy, these rates declined between 2007 and 2010. This happened despite the presence of women at higher risk of developing cardiovascular disease included in our registry over time,”concluded Roos-Hesselink.
The decline in adverse outcomes over the years may indicate increased awareness and improved management of pregnant women with cardiovascular disease.
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