AHA Statement Addresses Cardiovascular Health of Pregnant Women

Laxmi Mehta, MD

In an effort to improve the spectrum of care for mothers across the US, the American Heart Association (AHA)’s latest scientific statement addresses the cardiovascular considerations when caring for pregnant patients.

The statement, which was published in Circulation, details guidance and recommendations for cardiovascular care for women before, after, and during pregnancy.

"Cardiovascular diseases are the leading cause of pregnancy-related death and are increasing, possibly because women are having babies at older ages and are more likely to have preexisting heart disease or heart disease risk factors," said Laxmi Mehta, MD, writing group chair for the statement, and professor of medicine and director of preventive cardiology and women's cardiovascular health at The Ohio State University Wexner Medical Center, in a statement.

Penned by Mehta and a group of 9 colleagues, the 22-page document represents work from the AHA’s Council on Clinical Cardiology, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular and Stroke Nursing, and Stroke Council. In an effort to guide clinicians, the statement outlines the impact of pregnancy on women’s overall and cardiovascular health—as well as recommendations on how to care for women with a variety of conditions.

Among the early highlights of the document include a section of the physiologic changes that occur during pregnancy and how that impacts the body's interactions with certain drug classes, including antihypertensive and antithrombotic agents. The document also stresses the need for prepregnancy counseling and a multidisciplinary care team to mitigate maternal cardiovascular and obstetric risk and fetal risk during a potential pregnancy.

The statement also includes recommendations for care in the event of a patient suffers from a multitude of different cardiovascular conditions during pregnancy. Conditions of note included in the document are hypercholesterolemia, ischemic heart disease, cardiomyopathies, arrhythmias, valvular heart disease, and aortic disease. The document also references care for patients suffering from deep vein thrombosis, pulmonary embolism, and cerebrovascular disease.

"For each of these cardiac conditions, pregnancy can impact treatment as there are limitations in medication management and invasive procedures given the potential fetal risks…. Women should understand fetal risks and the risks to their own health posed by heart conditions before becoming pregnant," Mehta explained, in the aforementioned statement.

Also included in the document is an emphasis on lifestyle modifications, timing of delivery, and postpartum follow up.

A cornerstone in the prevention of virtually every cardiovascular condition, the scientific statement reviews data suggesting exercise and proper diet can pay dividends for maternal health—pointing out data that indicates regular exercise could improve health and prevent preeclampsia.

"The role of a healthy lifestyle during pregnancy—whether or not a woman has a cardiovascular condition—cannot be emphasized enough,” said Mehta.

In regard to timing of delivery, authors stress the importance of consulting with patients and understanding the risks and potential benefits associated with timing and various modes of delivery. For postpartum follow-up, authors highlight the need for discussions around contraception before discharge and identifying which patients should receive fourth-trimester follow-up.

This scientific statement, “Cardiovascular Considerations in Caring for Pregnant Patients,” is published in Circulation.