PREGNANCY AND HEART DISEASE.

This is something new that I did not know much about.
The European Society of Cardiology started a registry on pregnant women with heart disease in 2007. They have just published their registry data from 2007-2011. They published their data in the Sept 11th issue of the European Heart Journal. The lead author is Dr mark Johnson of the Imperial College London, UK. They followed 1,321 pregnant ladies with heart disease, across 28 countries, including developing and developed countries. They found that even in these times, females pregnant with heart disease had an 0.9% maternal mortality rate, compared to a normal population of 0.007%. Heart disease is a more common cause of death in pregnant females than DVT and hemorrhage. The most common heart disease was congenital HD ( 66% ), Valvular HD ( 25% ), cardiomyopathy ( 7% ), and Ischemic HD ( 2% ).  Pregnant females with heart disease in developing countries had a 6x higher mortality then their counterparts in developed countries.


Outcomes for women with heart disease compared with the normal pregnant population

Outcome	Normal population (%)	Congenital heart disease (%)	Valve disease (%)	Cardiomyopathy (%)	Ischemic heart disease (%)
Maternal mortality	0.007	0.5	2.1	2.4	0
Heart failure	0	8.0	18	24	8.0
C-section	23	38	42	58	60
Fetal death	0.35	0.5	3.9	4.5	4.0

Fetal mortality was also higher in pregnant females with heart disease. They are about 5x higher when compared to pregnant females without heart disease.
The call is for us to be more vigilant in assessing females with heart disease and take the appropriate measures before they become pregnant. Trying to diagnose heart disease in pregnancy, can be a challenge as some of the symptoms and signs may be mimic by normal pregnancy. In these days, with the echocardiogram freely available, diagnosis should be easier, and no one should be missed, if there is a high index of suspicion.
These facts are good to know.