Due to advances in screening and treatment, experts recently updated guidelines for the management of heart disease during pregnancy to reflect the latest evidence and research. Guidelines were published in the European Heart Journal and serve as an update to the 2012 European guidelines on heart disease and pregnancy. It must be noted that these guidelines are endorsed by the European Society of Cardiology and not the U.S.
As authors explain, these guidelines are designed to share knowledge about the risks associated with heart disease during pregnancy.
While many women with heart disease have completely healthy pregnancies and deliveries, pre-existing conditions are known to increase risk for complications. It’s estimated that pregnancy is complicated by existing conditions like heart disease in 14% of cases. Heart-related complications are among the most common types of pregnancy complications, such as heart attack, aortic dissection and peripartum cardiomyopathy.
As a result, experts note that women with heart disease should know about the risks before getting pregnant. Women should also be educated about potential treatments, as some therapies can be harmful to the baby while others may be less ideal for the mother.
For this reason, guidelines recommend performing a thorough risk assessment in all women of childbearing age with heart disease. The latest guidelines recommend this assessment before conception as a way to identify women at significantly increased risk for complications.
For certain women, guidelines also recommend treatment before pregnancy to help prevent complications down the road. For example, it’s recommended that certain women with a narrowing heart valve called mitral stenosis undergo treatment—potentially surgery—to correct the condition.
Guidelines also help specify which treatments women should consider during pregnancy, depending on their condition. They recommend that certain women be treated in centers with a pregnancy heart team to ensure that they receive the best guidance and care needed for a safe pregnancy.
Finally, guidelines also address labor and delivery in women with heart disease. For example, a c-section is recommended in women with a history of aortic dissection, since a vaginal delivery could put too much stress on the heart. The European guidelines also recommend induction of labor at 40 weeks in all pregnant women with heart disease, regardless of their condition.
Together, experts hope these updates will help minimize complications in women with heart disease during pregnancy. While research has helped greatly inform guidelines, experts explain that registries and studies are urgently needed to further our knowledge on the issue.