Heart disease in pregnancy

• Cardiac disease is the leading cause of maternal mortality in the developed world.
• Most deaths occur in women who are not known to have heart disease before pregnancy.
• Clinicians caring for pregnant women must be aware of the presentation and causes of cardiac disease.
• There must be a low threshold for investigation of women with possible cardiac symptoms and referral to Cardiology.
• Expert joint cardiac and obstetric pre-pregnancy and antenatal management are key to improving outcomes.

Cardiac disease is the leading cause of maternal mortality in the developed world. The majority of women with heart disease are able to successfully undergo pregnancy. However, in women with severely impaired ventricular function, severe left heart obstruction, pulmonary hypertension and aortopathy, such as Marfan syndrome, with significant aortic dilatation, pregnancy is associated with a significant risk, and these women should be counselled against pregnancy if there is no option for treatment that reduces risk. Although there are increasing numbers of women with congenital heart disease who are considering pregnancy, as a result of joint expert specialist cardiac and obstetric care, maternal mortality is low. Most of the observed mortality occurs in women with structurally normal hearts who were not known to have heart disease before their pregnancy. It is therefore important that those caring for pregnant women are aware of the risk factors for and presentation of cardiac conditions in pregnancy. We review the presentation and management of both congenital and acquired heart diseases in pregnancy.