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Pregnancy has always been a major concern in patients with heart disease. Although many women with pre-existing heart disorders tolerate pregnancy well, complications are frequent and in some cases include life threatening conditions for mother and child. In western countries maternal heart disease has indeed become the major cause of maternal death during pregnancy. Furthermore, pregnancy can have a negative impact on the long term course of heart disease.1 Thus, screening for heart disease, appropriate risk assessment, and counselling are crucial. In women at risk who nevertheless desire pregnancy or who present already pregnant, adequate measures during pregnancy and delivery that may reduce complications and optimise outcome have to be taken.
The spectrum of heart disease in pregnancy has changed and differs among regions around the world. In the western world, the risk of cardiovascular disease in pregnancy has increased because of advanced age at first pregnancy and the increasing prevalence of cardiovascular risk factors such as diabetes, hypertension, and obesity. More importantly, the improvement of congenital heart disease treatment has resulted in a significant number of women with heart disease now reaching childbearing age, and these represent the majority of pregnant women with heart disease. In a prospective multicentre study comprising 562 consecutive women and 599 pregnancies, Siu et al2 reported congenital heart disease in 74%. Acquired valvular heart disease was present in 22% of cases, and arrhythmias without structural heart disease in 4%. Coronary artery disease and cardiomyopathies (except for hypertrophic cardiomyopathy) were each reported in <1% of the women. In the non-western countries that still struggle with rheumatic fever, acquired valvular heart disease predominates by far. This article focuses on congenital and valvular heart disease as the two most common pre-existing cardiac disorders in pregnant women.
The European Society of Cardiology (ESC) has recently published …