Cardiac disease in pregnancy epidemiology and demographics

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Special Scenarios:

I. Pre-existing Cardiac Disease:
Congenital Heart Disease
Repaired Congenital Heart Disease
Pulmonary Hypertension
Rheumatic Heart Disease
Connective Tissue Disorders
II. Valvular Heart Disease:
Mitral Stenosis
Mitral Regurgitation
Aortic Insufficiency
Aortic Stenosis
Mechanical Prosthetic Valves
Tissue Prosthetic Valves
III. Cardiomyopathy:
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Peripartum Cardiomyopathy
IV. Cardiac diseases that may develop During Pregnancy:
Arrhythmias
Acute Myocardial Infarction
Hypertension

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Anjan K. Chakrabarti, M.D. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]

Overview

Cardiovascular diseases, including heart disease and stroke, account for more than one-third (33.6%) of all U.S. deaths.[4]Approximately 1-4% of pregnancies in the United States involve maternal cardiovascular disease. Heart disease along with deep venous thrombosis and pulmonary thromboembolism has surpassed hemorrhage, hypertensive disorders[1] and infection as the leading cause of maternal mortality.[2] 13% of pregnancies will be complicated by a cardiovascular event such as pulmonary edema, cardiac arrhythmia, stroke or cardiac death.

Epidemiology and Demographics

United States [5]

  • A pregnancy-related death is defined as the death of a woman while pregnant or within one year of pregnancy termination regardless of the duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
  • In the United States—
  • Of the 3,319 deaths within a year of pregnancy termination that occurred in 2006-2007, 1,294 were found to be pregnancy-related.
  • The pregnancy-related mortality ratio was 15.1 deaths per 100,000 live births for the period 2006–2007.
  • Considerable racial disparities in pregnancy-related mortality exist and during the 2006–2007 period, the pregnancy-related mortality ratios were:
  • 11.0 deaths per 100,000 live births for white women.
  • 34.8 deaths per 100,000 live births for black women.
  • 15.7 deaths per 100,000 live births for women of other races.
  • The graph below depicts the causes for pregnancy-related deaths in the United States for the year 2006-2007.
CDC Pregnancy related death year2006 07.jpg


Developed and Developing Countries

  • Increasing numbers of women with congenital heart disease are now reaching childbearing age.
  • Congential heart disease is now the most common form of heart disease complicating pregnancy in the United States.
  • Rheumatic heart disease still predominates in developing countries and in immigrant populations in the United States.
  • Maternal death during pregnancy in women with heart disease is rare; conditions that are associated with increased mortality includeEisenmenger syndrome, pulmonary vascular obstructive disease, and Marfan syndrome with aortopathy.[3]
  • In a prospective study of 562 pregnant women with heart disease (aged 28 ± years) at 13 Canadian cardiac and obstetric teaching hospitals, a primary cardiac event occurred in 80 completed pregnancies (13%), the most common complications being pulmonary edema and cardiacarrhythmia.[4]

Resources

  • CDC: Pregnancy-related mortality in the United States, 1987–1990.[5]

References

  1. Peters RM, Flack JM (2004). "Hypertensive disorders of pregnancy". Journal of Obstetric, Gynecologic, and Neonatal Nursing : JOGNN / NAACOG. 33 (2): 209–20. PMID 15095800. Retrieved 2012-04-17.
  2. CEMACH. CEMACH Saving Mothers’ Lives: Reviewing Maternal Deaths to Make Motherhood safer—2003 –2005: The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. London: Centre for Maternal and Child Enquiries; 2008
  3. Siu SC, Colman JM (2001). "Heart disease and pregnancy". Heart. 85 (6): 710–5. PMC 1729784. PMID 11359761.
  4. Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC; et al. (2001). "Prospective multicenter study of pregnancy outcomes in women with heart disease". Circulation. 104 (5): 515–21. PMID 11479246.
  5. Berg CJ, Atrash HK, Koonin LM, Tucker M (1996). "Pregnancy-related mortality in the United States, 1987-1990". Obstetrics and Gynecology. 88 (2): 161–7. doi:10.1016/0029-7844(96)00135-4. PMID 8692494. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)


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