Heart disease in pregnancy

Following progressive improvements in pregnancy-related healthcare in industrialized nations during the last two decades, maternal mortality and morbidity are low. Nonetheless, heart disease remains the principal cause of maternal death, and most deaths are attributable to previously undiagnosed cardiac conditions. Pregnancy-related cardiac disease covers a spectrum of pathologies including arrhythmias, ischaemic heart disease, valvular dysfunction, prosthetic valves, aortic pathology and congenital abnormalities, either acquired/diagnosed during pregnancy or previously identified. Pregnancy exerts a physiological stress that is generally well tolerated by a structurally and functionally normal heart, but may cause clinical deterioration in women with underlying cardiac disease. An ageing obstetric population with increasingly relevant cardiovascular risk factors and comorbidities is giving rise to a greater incidence of cardiac conditions occurring for the first time during pregnancy. Pre-pregnancy counselling is an essential component for women with recognized disease. Most women with both acquired and pre-existing disorders will undergo a successful pregnancy, with some needing limited clinical input. Identification of high-risk pregnancies with regular monitoring using a specialist multi-disciplinary team approach is paramount to good maternal and fetal outcomes.