Most women with heart disease can shun advice to avoid pregnancy

By Piriya Mahendra, medwireNews Reporter

The majority of women with structural or ischemic heart disease can safely undergo pregnancy with extensive pre-evaluation and high-quality care, say researchers.

The world's first registry of pregnancy in heart disease showed that although the rate of maternal mortality in women with heart disease is higher than that of the general population, at 1% versus 0.007%, most women can still safely carry to full-term with the right care.

Speaking to medwireNews, co-author Roger Hall (Norwich Medical School, UK) said: "In the past there's been blanket advice to women who have heart disease that they'd better not have a pregnancy. We're trying to say actually many people who have heart disease are perfectly safe to go ahead with pregnancy."

Hall explained that specialized care for these women must focus on monitoring. "We have shown that there is a very high instance of patients needing to be admitted to hospital with problems [26%] when they can often, despite that, carry to term.

"They need careful surveillance and good counseling before pregnancy if possible. If it is possible to talk to them in advance then you can plan their pregnancy and how to manage it. You can make sure they're not given inappropriate drugs and that they are treated quickly if they develop problems."

The analysis, published in the European Heart Journal, revealed that pregnant women with a cardiomyopathy are at higher risk for complications than those with other types of heart disease. Indeed, maternal mortality was highest in these women, at 2.4%.

Congenital heart disease was the most prevalent condition in the registry (66%), followed by valvular heart disease (25%), cardiomyopathy (7%), and ischemic heart disease (2%).

The study also showed that in developing countries, women with heart disease and their babies were significantly more likely to die than those in developed countries, who were more likely to access better care and counseling.

Indeed, maternal mortality occurred in 3.9% of women in developing countries compared with 0.6% in developed countries, while 6.5% of fetuses died in developing countries compared with 0.9% in developed countries.

While Hall said that the potential reasons for the higher mortality in these countries, including India and Egypt, are controversial, he has future plans for the registry to analyze this finding in more detail.

The European Registry on Pregnancy and Heart Disease was initiated by the European Society of Cardiology in 2007. It involves sixty hospitals from 28 countries and enrolled 1321 pregnant women between 2007 and 2011 with a median maternal age of 30 years.

The current analysis is just part of an expanding registry, which Hall hopes will grow to include over 5000 patients in a few years' time. "We are hoping to define - and we already are to some extent - the situation. This is part of an ongoing study."

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