New Guideline for Pregnant Mothers with High Blood Pressure and Cardiovascular Disease

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The incidence of women who are both pregnant and have a heart disorder is a growing concern for life-threatening medical conditions that affect both a mother and her fetus. In Europe, heart disease has become the major cause of maternal death during pregnancy. Because of this, the European Society of Cardiology has recently published a comprehensive set of guidelines for physicians and patients toward managed care of pregnant women with high blood pressure and cardiovascular disease.

A need for guidance for pregnant women
The recent guideline published in the European Heart Journal is the culmination of a systematic search of medical literature from the past 20 years in the National Institutes of Health database known as PubMed. The need for a guideline is due to the growing trend of women who are increasingly older by the time they have their first child—a time when diabetes, hypertension and obesity become health concerns for this age group. High blood pressure and related disorders occur in 6-8% of all pregnancies and are among the most common cardiovascular events faced by expectant mothers. Congenital heart disease, however, is the most common cardiovascular disease during pregnancy, occurring as has high as 75 to 83%.

As a comprehensive review, the guideline lists a thorough discussion of the most common and important medical conditions relating to pregnancy and its effect on both mother and fetus. The list includes:

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• General considerations
• Congenital heart disease and pulmonary hypertension
• Aortic diseases
• Maternal and offspring risk
• Specific syndromes
• Recommendations for the management of aortic disease
• Valvular heart disease
• Coronary artery disease
• Cardiomyopathies
• Arrhythmias
• Hypertensive disorders
• Venous thromboembolism
• Drugs during pregnancy and breastfeeding

While the guidelines are thorough, they are still guidelines and are not meant be interpreted and treated as absolutes toward healthcare in pregnant women. According to the authors of the guideline, “The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and, where appropriate and necessary, the patient's guardian or carer.”

For those who have a family history of hypertension or cardiac problems and are pregnant or considering becoming pregnant, the guideline is available free online at http://eurheartj.oxfordjournals.org/content/early/2011/08/26/eurheartj.ehr218.full#sec-237.

Source: “ESC Guidelines on the management of cardiovascular diseases during pregnancy”
Eur. Heart J. (2011); doi: 10.1093/eurheartj/ehr218, published online: August 26, 2011

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