Women with cardiovascular conditions should be cared for during pregnancy by a cardio-obstetrics team or health care providers experienced in high-risk pregnancies to provide specialized maternity care for the mother and fetus, according to a new American Heart Association scientific statement, Cardiovascular Considerations in Caring for Pregnant Patients, published today in the Association's flagship journal Circulation .
Cardiovascular diseases are the leading cause of pregnancy-related death and are increasing, possibly because women are having babies at older ages and are more likely to have preexisting heart disease or heart disease risk factors." Laxmi Mehta, M.D., Chairperson, Professor, and Director, Ohio State University Wexner Medical Center
Advanced maternal age - defined as age 35 or above - is associated with a higher risk of premature birth, chronic hypertension, preeclampsia (pregnancy-related high blood pressure) and/or gestational diabetes.
Women who are planning to become pregnant and who have preexisting cardiovascular conditions, such as chronic high blood pressure, a history of preeclampsia, heart muscle disease (cardiomyopathies), diabetes, high cholesterol, previous heart attacks, heart valve disorders, aortic dilatation and/or congenital heart disease should receive preconception counseling by a cardio-obstetrics team or health care providers experienced in high-risk pregnancies.
"For each of these cardiac conditions, pregnancy can impact treatment as there are limitations in medication management and invasive procedures given the potential fetal risks. For example, statin medications should not be used to lower cholesterol during pregnancy because these drugs could cause fetal abnormalities, according to the most recent cholesterol guidelines.
Women should understand fetal risks and the risks to their own health posed by heart conditions before becoming pregnant," said Mehta. "If a woman is taking statin drugs, they should be discontinued one to two months before pregnancy is attempted."
Blood pressure changes are normal during pregnancy, however, blood pressure should be monitored closely.
The most common cardiovascular events during pregnancy are related to high blood pressure disorders such as preeclampsia, defined as systolic blood pressure >140 mmHg or diastolic blood pressure > 90 mmHg in women after 20 weeks of gestation who had normal blood pressure before pregnancy.
It can lead to serious complications including liver or kidney dysfunction, headaches, vision changes and/or fluid overload in the lungs and is also a leading factor for premature birth and cesarean delivery.
Women with a history of preeclampsia have a 71% greater risk of dying from heart disease or stroke over their lifetime compared to women who have never had preeclampsia, according to the statement. There are effective treatments to prevent or manage preeclampsia; however, treatment must be carefully individualized.
The statement reports that several studies have proposed that regular exercise during pregnancy may improve the way blood vessels function and may even prevent preeclampsia; additional studies need to be conducted to verify these findings.
The role of a healthy lifestyle during pregnancy - whether or not a woman has a cardiovascular condition - cannot be emphasized enough. Healthy diet, moderate exercise including walking, smoking cessation and other healthy behaviors are important tools for a healthy pregnancy for both mother and child." Laxmi Mehta, M.D., Chairperson, Professor, and Director, Ohio State University Wexner Medical Center Related Stories
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