Maternal cardiac disease in pregnancy

Abstract

The 2024 MBRRACE-UK report showed a rise in overall maternal mortality, with deaths from cardiac disease remaining the main indirect cause, barring deaths from COVID-19. Advancing maternal age and a rise in cardiovascular co-morbidities, along with improvements in congenital heart disease management and assisted reproductive technology have all contributed to an increasingly complex maternity population with higher pregnancy risks. Despite improvements in obstetric and cardiac care, health inequalities for women with multiple comorbidities, socio-economic deprivation and those from Black and Asian ethnic groups persist, with these groups being more likely to have poor cardiovascular and pregnancy outcomes. In this review we consider the importance of pre-conception counselling for women with known heart disease, review the physiological changes of pregnancy and explore maternal risk, from a cardiovascular perspective. Importantly, management of women with moderate to severe heart disease during pregnancy should be delivered by the pregnancy heart team, as coined by the European Society of Cardiology in its 2018 guidelines. Individualized care empowers trust and shared decision making, and early access to multidisciplinary care is vital in optimizing maternal and fetal outcomes.