Cardiovascular Health Management During Pregnancy
Summary
Pregnancy imposes profound haemodynamic, hormonal and metabolic adaptations on the maternal cardiovascular system. Cardiac output increases by up to 50 per cent, systemic vascular resistance falls and blood volume expands, demanding careful surveillance in women with pre-existing or acquired cardiac conditions. Optimal management hinges on early risk stratification, interdisciplinary care and individualised therapy to balance maternal benefit and foetal safety. Key challenges include the diagnosis and treatment of peripartum cardiomyopathy, hypertensive disorders such as preeclampsia, arrhythmias and valvular or congenital heart disease. Echocardiographic assessment of left ventricular ejection fraction guides heart failure therapy, while biomarkers such as natriuretic peptides can aid in prognosis. Anticoagulation strategies must be tailored for mechanical valve recipients or prothrombotic states without compromising foetal development. Moreover, hypertensive complications demand a judicious choice of antihypertensive agents to mitigate risks of placental ischaemia and adverse neonatal outcomes. A multidisciplinary cardio-obstetric team ensures coordinated antenatal monitoring, delivery planning and postpartum follow-up, addressing the continuum from pre-conception counselling to long-term cardiovascular health.
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Cardiovascular Health Management During Pregnancy publication trend
The graph below shows the total number of articles in cardiovascular health management during pregnancy across all publications each year (not limited to Nature Index journals).
Technical terms
Left ventricular ejection fraction (LVEF): The percentage of blood ejected from the left ventricle with each heartbeat, used to assess systolic function.
Peripartum cardiomyopathy (PPCM): A form of heart failure occurring in late pregnancy or early postpartum in women without prior cardiac disease.
N-terminal pro-brain natriuretic peptide (NT-proBNP): A biomarker released in response to ventricular wall stress, indicative of heart failure severity.
Adult congenital heart disease (ACHD): Structural heart defects present from birth persisting into adulthood, influencing pregnancy outcomes.
Anticoagulation: The use of agents to prevent thromboembolic events, crucial in mechanical valve recipients during pregnancy.
Preeclampsia: A hypertensive disorder of pregnancy characterised by high blood pressure and organ dysfunction, posing cardiovascular risk.
References
- Prognostic value of NT-proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM). Clinical Research in Cardiology (2021).
- Association of Adult Congenital Heart Disease With Pregnancy, Maternal, and Neonatal Outcomes. JAMA Network Open (2019).
- Maternal and Fetal Outcomes of Anticoagulation in Pregnant Women With Mechanical Heart Valves. Journal of the American College of Cardiology (2017).
- Cardiovascular adverse events in pregnancy: A global perspective. Global Cardiology Science and Practice (2021).
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