Screening crucial for growing numbers of pregnant women with heart disease
New guidelines from the European Society of Cardiology (ESC) for managing cardiovascular disease (CVD) in pregnancy emphasize the importance of screening, risk assessment, and patient counseling in light of the rising risk of heart disease among pregnant women in developed countries. CVD complicates 0.2% to 4% of pregnancies in western industrialized nations.
New guidelines from the European Society of Cardiology (ESC) for managing cardiovascular disease (CVD) in pregnancy emphasize the importance of screening, risk assessment, and patient counseling in light of the rising risk of heart disease among pregnant women in developed countries. CVD complicates 0.2% to 4% of pregnancies in western industrialized nations.
The authors of the guidelines, which were published online August 26 in the European Heart Journal, write that the risk is increasing primarily because women tend to be older at first pregnancy than in the past and therefore have a higher risk of diabetes, hypertension, and obesity. Moreover, a larger number of women with congenital heart disease are reaching childbearing age because of advances in treatment. Pre-existing heart disease is rarely a contraindication to pregnancy, but complications occur often and may threaten the life of both mother and child.
The number of pregnant patients with cardiovascular problems seen by any one physician is small, but, the authors write, “knowledge of the risks associated with CVD during pregnancy and their management are of pivotal importance for advising patients before pregnancy. Therefore, guidelines on disease management in pregnancy are of great relevance.” Recommendations should give special consideration to the effect of treatment on the infant as well as the mother, they add.
A large share of screening, risk assessment, and counseling can be performed by primary care providers, but interdisciplinary teams should manage suspected or confirmed CVD, the guidelines recommend. Specialized centers should treat high-risk patients. The ESC guidelines include recommendations for follow-up during pregnancy, appropriate medical therapy, and delivery and postpartum care.
For lack of conclusive evidence, issues not addressed by the guidelines’ authors include the degree of less-severe pulmonary hypertension at which pregnancy is contraindicated and the role of anticoagulation therapy in patients with artificial heart valves or other indications.
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