Cardiovascular disease in pregnancy

In the latest Confidential Enquiry into Maternal and Child Health, cardiac disease remains the leading cause of maternal death in the UK. Increasing maternal age and extended survival of patients with complex congenital disease are partly responsible for a rising number of patients with cardiac disease in pregnancy. Another large proportion consists of patients with rheumatic disease (often previously undiagnosed) who present for the first time in pregnancy. Furthermore, maternal obesity and diabetes predispose to a rising number of deaths related to coronary artery disease. In all cases, early referral to a specialist centre (ideally before conception) and management by a multidisciplinary team are essential. It is important to be vigilant for new cardiovascular disease developing during pregnancy or in the postpartum period. Equally important is awareness of physiological changes of the cardiovascular system occurring during normal pregnancy.