Pregnant women with heart disease need specialized care

Women with heart disease – the leading cause of death during pregnancy – should be closely cared for by a specialized team during pregnancy, according to a new report from the American Heart Association.

Women with preexisting cardiovascular conditions, such as chronic high blood pressure, heart disease and high cholesterol, would benefit from careful monitoring and counseling, from preconception until post-childbirth, the scientific statement says. Doctors may choose to prescribe regular exercise, medications or other strategies.

"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," Dr. Laxmi Mehta, chair of the group that wrote the statement, said in a news release. Mehta is a professor of medicine and director of preventive cardiology and women's cardiovascular health at The Ohio State University Wexner Medical Center in Columbus, Ohio.

"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."

Between 1987 and 2015, pregnancy-related deaths rose from 7.2 to 17.2 deaths per 100,000 live births in the United States, according to the statement published Monday in the American Heart Association's journal Circulation. It highlights several potential dangers for women with heart issues that could be helped with the correct treatment.

For example, pregnant women with the high blood pressure disorder called preeclampsia have a 71% greater risk of dying from heart disease or stroke over their lifetime. The statement reports that several studies have linked regular exercise during pregnancy to preeclampsia prevention.

Other conditions may require pharmaceutical intervention. Pregnant women with valvular heart disease, which increases the risk of a clot-caused ischemic stroke, could benefit from medications after the first trimester to reduce clotting, the statement says.

Heart rhythm disorders could be treated with medication or surgery if they are severe enough. Data show these disorders are on the rise, potentially because women are having babies later in life.

Older mothers should take extra precautions, the statement says. Advanced maternal age – defined as 35 or older – is associated with a higher risk of premature birth, chronic hypertension, preeclampsia and gestational diabetes.

The statement recommends women with preexisting cardiovascular disease be cared for by a cardio-obstetrics team that includes an obstetrician, cardiologist, anesthesiologist, maternal-fetal medicine specialist and nurses.

While medications may help some patients, all expectant mothers should recognize the importance of healthy habits, Mehta said.

"The role of a healthy lifestyle during pregnancy – whether or not a woman has a cardiovascular condition – cannot be emphasized enough," she said. "Healthy diet, moderate exercise including walking, smoking cessation and other healthy behaviors are important tools for a healthy pregnancy for both mother and child."

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