Skip to main content

Advertisement

SpringerLink
Log in

Cardiovascular Complications in Pregnancy

  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

We review the epidemiology, risk factors, presentation, pathophysiology, diagnosis, peripartum management, and postpartum follow-up of chronic hypertension, hyperlipidemia, acute myocardial infarction, stroke, heart failure, pulmonary embolism, and atrial fibrillation.

Recent findings

We discuss pathophysiology and evidence-based management for chronic hypertension, hyperlipidemia, acute myocardial infarction, stroke, heart failure, pulmonary embolism, and atrial fibrillation.

Summary

It is essential for providers and patients to understand how cardiovascular diseases cause complications in pregnancy and to identify when patients require screening before conception and throughout the pregnancy. While primary care physicians, obstetricians, and cardiologists, should all have a general understanding of cardiovascular diseases during pregnancy, for higher risk patients it is important to create a multi-disciplinary cardio-obstetrics team for preconception planning, and for risk reduction during and after pregnancy. Shared decision-making regarding risks and benefits is crucial to improve maternal morbidity and mortality in the United States.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as:

    • Of importance

    1. Collier AY, Molina RL. Maternal mortality in the United States: updates on trends, causes, and solutions. NeoReviews. 2019;20(10):e561–74.

      Article  PubMed  PubMed Central  Google Scholar 

    2. • Mehta LS, et al. Cardiovascular considerations in caring for pregnant patients: a scientific statement from the American Heart Association. Circulation. 2020;141(23):e884–903. This scientific statement published from the American Heart Association provides a succinct outline of the prevalence and management of various cardiovascular complications in pregnant patients including: hypertension, hypercholesterolemia, cardiomyopathy, arrhythmia, valvular heart disease, aortic disease, deep vein thrombosis and pulmonary embolism, and cerebrovascular disease.

    3. • Park K, et al. Management of women with acquired cardiovascular disease from pre-conception through pregnancy and postpartum: JACC focus seminar 3/5. J Am Coll Cardiol. 2021;77(14):1799–812. This Focus Seminar published in the Journal of the American College of Cardiology provides insight into preconception, peripartum and postpartum management of various pathologies including: arrhythmia, cardiomyopathy, hypertension and ischemic heart disease.

    4. Goyal N, et al. Maternal cardiovascular complications at the time of delivery and subsequent re-hospitalization in the USA, 2010–16. Eur Heart J Qual Care Clin Outcomes. 2021;7(3):304–11.

      Article  PubMed  Google Scholar 

    5. Wang MC, et al. Trends in prepregnancy obesity and association with adverse pregnancy outcomes in the United States, 2013 to 2018. J Am Heart Assoc. 2021;10(17): e020717.

      Article  PubMed  PubMed Central  Google Scholar 

    6. Murphy SL, et al. Mortality in the United States, 2020. NCHS Data Brief. 2021;427:1–8.

      Google Scholar 

    7. MacDorman MF, et al. Racial and ethnic disparities in maternal mortality in the United States using enhanced vital records, 2016–2017. Am J Public Health. 2021;111(9):1673–81.

      Article  PubMed  PubMed Central  Google Scholar 

    8. American College of O, et al. ACOG Practice bulletin no. 212: pregnancy and heart disease. Obstet Gynecol, 2019;133(5):e320-e356.

    9. Melchiorre K, Sharma R, Thilaganathan B. Cardiovascular implications in preeclampsia: an overview. Circulation. 2014;130(8):703–14.

      Article  PubMed  Google Scholar 

    10. Lin YS, et al. Effect of pre-eclampsia-eclampsia on major cardiovascular events among peripartum women in Taiwan. Am J Cardiol. 2011;107(2):325–30.

      Article  PubMed  Google Scholar 

    11. Regitz-Zagrosek V, et al. ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165–241.

      Article  PubMed  Google Scholar 

    12. Leeson P. Chronic hypertension in pregnancy project and the control of hypertension in pregnancy study: impact of blood pressure control in pregnancy on maternal and fetal outcomes. Cardiovasc Res. 2022;118(14):e98–100.

      Article  CAS  PubMed  Google Scholar 

    13. Sibai BM, et al. Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med, 1998;339(10):667–71.

    14. Sibai BM. Chronic hypertension in pregnancy. Obstet Gynecol. 2002;100(2):369–77.

      PubMed  Google Scholar 

    15. Seely EW, Ecker J. Chronic hypertension in pregnancy. Circulation. 2014;129(11):1254–61.

      Article  PubMed  Google Scholar 

    16. American College of O and Gynecologists ACOG committee opinion number 315, September 2005. Obesity in pregnancy. Obstet Gynecol, 2005;106(3):671–5.

    17. Magee LA, et al. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med. 2015;372(5):407–17.

      Article  CAS  PubMed  Google Scholar 

    18. Croke L. Managing chronic hypertension in pregnant women: ACOG releases updated practice bulletin. Am Fam Physician. 2019;100(12):782–3.

      PubMed  Google Scholar 

    19. Gestational hypertension and preeclampsia. ACOG practice bulletin, number 222. Obstet Gynecol. 2020;135(6):e237–60.

      Article  Google Scholar 

    20. American College of O and SfM-FM Gynecologists' Committee on Obstetric Practice, Medically indicated late-preterm and early-term deliveries: ACOG committee opinion, number 831. Obstet Gynecol, 2021;138(1):e35-e39.

    21. Clark SM, Dunn HE, Hankins GD. A review of oral labetalol and nifedipine in mild to moderate hypertension in pregnancy. Semin Perinatol. 2015;39(7):548–55.

      Article  PubMed  Google Scholar 

    22. Lindheimer MD, et al. ASH position paper: hypertension in pregnancy. J Clin Hypertens (Greenwich). 2009;11(4):214–25.

      Article  PubMed  Google Scholar 

    23. Tita AT, Szychowski JM, Andrews WW. Treatment for Mild chronic hypertension during pregnancy. Reply N Engl J Med. 2022;387(7):664.

      PubMed  Google Scholar 

    24. Amaral LM, et al. Pathophysiology and current clinical management of preeclampsia. Curr Hypertens Rep. 2017;19(8):61.

      Article  PubMed  PubMed Central  Google Scholar 

    25. Bolte AC, van Geijn HP, Dekker GA. Management and monitoring of severe preeclampsia. Eur J Obstet Gynecol Reprod Biol. 2001;96(1):8–20.

      Article  CAS  PubMed  Google Scholar 

    26. Nizamuddin J, et al. Hypertensive diseases of pregnancy increase risk of readmission with heart failure: a national readmissions database study. Mayo Clin Proc. 2019;94(5):811–9.

      Article  PubMed  Google Scholar 

    27. Jacobson TA, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1 - executive summary. J Clin Lipidol. 2014;8(5):473–88.

      Article  PubMed  Google Scholar 

    28. Wiznitzer A, et al. Association of lipid levels during gestation with preeclampsia and gestational diabetes mellitus: a population-based study. Am J Obstet Gynecol, 2009;201(5):482 e1–8.

    29. Vrijkotte TG, et al. Maternal lipid profile during early pregnancy and pregnancy complications and outcomes: the ABCD study. J Clin Endocrinol Metab. 2012;97(11):3917–25.

      Article  CAS  PubMed  Google Scholar 

    30. Endresen MJ, Lorentzen B, Henriksen T. Increased lipolytic activity and high ratio of free fatty acids to albumin in sera from women with preeclampsia leads to triglyceride accumulation in cultured endothelial cells. Am J Obstet Gynecol. 1992;167(2):440–7.

      Article  CAS  PubMed  Google Scholar 

    31. Kaaja R, et al. Serum lipoproteins, insulin, and urinary prostanoid metabolites in normal and hypertensive pregnant women. Obstet Gynecol. 1995;85(3):353–6.

      Article  CAS  PubMed  Google Scholar 

    32. Stone NJ, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014;63(25 Pt B):2889–934.

    33. Dukic A, et al. Hyperlipidemia and pregnancy. Med Pregl. 2009;62(Suppl 3):80–4.

      PubMed  Google Scholar 

    34. Grundy SM, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082–143.

      PubMed  Google Scholar 

    35. Mauricio R, Khera A. Statin use in pregnancy: is it time for a paradigm shift? Circulation. 2022;145(7):496–8.

      Article  PubMed  Google Scholar 

    36. Hankins GD, et al. Myocardial infarction during pregnancy: a review. Obstet Gynecol. 1985;65(1):139–46.

      CAS  PubMed  Google Scholar 

    37. Creanga AA, et al. Pregnancy-related mortality in the United States, 2011–2013. Obstet Gynecol. 2017;130(2):366–73.

      Article  PubMed  PubMed Central  Google Scholar 

    38. Burchill LJ, et al. Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome. Heart. 2015;101(7):525–9.

      Article  CAS  PubMed  Google Scholar 

    39. James AH, et al. Acute myocardial infarction in pregnancy: a United States population-based study. Circulation. 2006;113(12):1564–71.

      Article  PubMed  Google Scholar 

    40. Gupta A, et al. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol. 2014;64(4):337–45.

      Article  PubMed  PubMed Central  Google Scholar 

    41. Faden MS, et al. A nationwide evaluation of spontaneous coronary artery dissection in pregnancy and the puerperium. Heart. 2016;102(24):1974–9.

      Article  PubMed  Google Scholar 

    42. Hayes SN, et al. Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association. Circulation. 2018;137(19):e523–57.

      Article  PubMed  PubMed Central  Google Scholar 

    43. Ito H, et al. Presentation and therapy of spontaneous coronary artery dissection and comparisons of postpartum versus nonpostpartum cases. Am J Cardiol. 2011;107(11):1590–6.

      Article  PubMed  Google Scholar 

    44. Tweet MS, et al. Association of pregnancy with recurrence of spontaneous coronary artery dissection among women with prior coronary artery dissection. JAMA Netw Open. 2020;3(9): e2018170.

      Article  PubMed  PubMed Central  Google Scholar 

    45. Halpern DG, et al. Use of medication for cardiovascular disease during pregnancy: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73(4):457–76.

      Article  PubMed  Google Scholar 

    46. Levine GN, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI guideline for Percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation. 2016;134(10):e123–55.

      PubMed  Google Scholar 

    47. Amsterdam EA, et al. 2014 AHA/ACC Guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139–228.

      Article  PubMed  Google Scholar 

    48. Kuba K, et al. Percutaneous coronary intervention in pregnancy: modeling of the fetal absorbed dose. Case Rep Obstet Gynecol. 2019;2019:8410203.

      PubMed  PubMed Central  Google Scholar 

    49. Tweet MS, et al. Pregnancy-associated myocardial infarction: prevalence, causes, and interventional management. Circ Cardiovasc Interv, 2020;CIRCINTERVENTIONS120008687.

    50. Claeys MJ, et al. Summary of 2018 ESC Guidelines on definition of myocardial infarction, myocardial revascularisation, cardiovascular disease during pregnancy and on arterial hypertension. Acta Cardiol. 2020;75(3):179–85.

      Article  PubMed  Google Scholar 

    51. Davis MB, et al. Peripartum cardiomyopathy: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(2):207–21.

      Article  CAS  PubMed  Google Scholar 

    52. Honigberg MC, Givertz MM. Peripartum cardiomyopathy. BMJ. 2019;364: k5287.

      Article  PubMed  Google Scholar 

    53. Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895–1032.

      PubMed  Google Scholar 

    54. Regitz-Zagrosek V, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: the task force for the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(34):3165–241.

      Article  PubMed  Google Scholar 

    55. Fett JD. Earlier detection can help avoid many serious complications of peripartum cardiomyopathy. Future Cardiol. 2013;9(6):809–16.

      Article  CAS  PubMed  Google Scholar 

    56. Gunderson EP, et al. Epidemiology of peripartum cardiomyopathy: incidence, predictors, and outcomes. Obstet Gynecol. 2011;118(3):583–91.

      Article  PubMed  Google Scholar 

    57. Hoevelmann J, et al. A global perspective on the management and outcomes of peripartum cardiomyopathy: a systematic review and meta-analysis. Eur J Heart Fail. 2022;24(9):1719–36.

      Article  PubMed  Google Scholar 

    58. Bello N, Rendon ISH, Arany Z. The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol. 2013;62(18):1715–23.

      Article  PubMed  PubMed Central  Google Scholar 

    59. Afana M, et al. Characteristics and in-hospital outcomes of peripartum cardiomyopathy diagnosed during delivery in the United States from the Nationwide Inpatient Sample (NIS) database. J Card Fail. 2016;22(7):512–9.

      Article  PubMed  Google Scholar 

    60. Lamparter S, Pankuweit S, Maisch B. Clinical and immunologic characteristics in peripartum cardiomyopathy. Int J Cardiol. 2007;118(1):14–20.

      Article  PubMed  Google Scholar 

    61. Bello NA, Arany Z. Molecular mechanisms of peripartum cardiomyopathy: a vascular/hormonal hypothesis. Trends Cardiovasc Med. 2015;25(6):499–504.

      Article  CAS  PubMed  PubMed Central  Google Scholar 

    62. Goli R, et al. Genetic and phenotypic landscape of peripartum cardiomyopathy. Circulation. 2021;143(19):1852–62.

      Article  CAS  PubMed  PubMed Central  Google Scholar 

    63. Hameed AB, et al. Longitudinal changes in the B-type natriuretic peptide levels in normal pregnancy and postpartum. Clin Cardiol. 2009;32(8):E60–2.

      Article  PubMed  PubMed Central  Google Scholar 

    64. Sliwa K, et al. Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM. Eur J Heart Fail. 2017;19(9):1131–41.

      Article  CAS  PubMed  Google Scholar 

    65. Goland S, et al. Clinical profile and predictors of complications in peripartum cardiomyopathy. J Card Fail. 2009;15(8):645–50.

      Article  PubMed  Google Scholar 

    66. Honigberg MC, et al. Electrocardiographic findings in peripartum cardiomyopathy. Clin Cardiol. 2019;42(5):524–9.

      Article  PubMed  PubMed Central  Google Scholar 

    67. Hoevelmann J, et al. Detection and management of arrhythmias in peripartum cardiomyopathy. Cardiovasc Diagn Ther. 2020;10(2):325–35.

      Article  PubMed  PubMed Central  Google Scholar 

    68. Liang YD, et al. Left ventricular function recovery in peripartum cardiomyopathy: a cardiovascular magnetic resonance study by myocardial T1 and T2 mapping. J Cardiovasc Magn Reson. 2020;22(1):2.

      Article  PubMed  PubMed Central  Google Scholar 

    69. Waksmonski CA. Cardiac imaging and functional assessment in pregnancy. Semin Perinatol. 2014;38(5):240–4.

      Article  PubMed  Google Scholar 

    70. Chapa JB, et al. Prognostic value of echocardiography in peripartum cardiomyopathy. Obstet Gynecol. 2005;105(6):1303–8.

      Article  PubMed  Google Scholar 

    71. Li W, Li H, Long Y. Clinical characteristics and long-term predictors of persistent left ventricular systolic dysfunction in peripartum cardiomyopathy. Can J Cardiol. 2016;32(3):362–8.

      Article  PubMed  Google Scholar 

    72. Bauersachs J, et al. Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2016;18(9):1096–105.

      Article  PubMed  Google Scholar 

    73. Koenig T, Bauersachs J, Hilfiker-Kleiner D. Bromocriptine for the treatment of peripartum cardiomyopathy. Card Fail Rev. 2018;4(1):46–9.

      Article  PubMed  PubMed Central  Google Scholar 

    74. Trongtorsak A, et al. Effects of bromocriptine in peripartum cardiomyopathy: a systematic review and meta-analysis. Heart Fail Rev. 2022;27(2):533–43.

      Article  CAS  PubMed  Google Scholar 

    75. Tapaskar N, Tremblay-Gravel M. and Khush KK. Contemporary management of cardiogenic shock during pregnancy. J Card Fail, 2022.

    76. Kiriyama Y, et al. Outcomes of severe peripartum cardiomyopathy and mechanical circulatory support: a case series. JA Clin Rep. 2021;7(1):80.

      Article  PubMed  PubMed Central  Google Scholar 

    77. Grewal J, Windram J, Silversides C. Cardio-obstetrics: past, present and future. Can J Cardiol. 2021;37(12):1902–3.

      Article  PubMed  Google Scholar 

    78. Davis MB, Walsh MN. Cardio-obstetrics Circ Cardiovasc Qual Outcomes. 2019;12(2): e005417.

      Article  PubMed  Google Scholar 

    79. Koczo A, et al. Breastfeeding, cellular immune activation, and myocardial recovery in peripartum cardiomyopathy. JACC Basic Transl Sci. 2019;4(3):291–300.

      Article  PubMed  PubMed Central  Google Scholar 

    80. Mallikethi-Reddy S, et al. Burden of arrhythmias in peripartum cardiomyopathy: analysis of 9841 hospitalizations. Int J Cardiol. 2017;235:114–7.

      Article  PubMed  Google Scholar 

    81. Roos-Hesselink JW, et al. Contraception and cardiovascular disease. Eur Heart J, 2015;36(27):1728–34, 1734a-1734b.

    82. Elkayam U. Risk of subsequent pregnancy in women with a history of peripartum cardiomyopathy. J Am Coll Cardiol. 2014;64(15):1629–36.

      Article  PubMed  Google Scholar 

    83. Katz R, Karliner JS, Resnik R. Effects of a natural volume overload state (pregnancy) on left ventricular performance in normal human subjects. Circulation. 1978;58(3 Pt 1):434–41.

      Article  CAS  PubMed  Google Scholar 

    84. Lee MS, et al. Atrial Fibrillation and atrial flutter in pregnant women-a population-based study. J Am Heart Assoc. 2016;5(4): e003182.

      Article  PubMed  PubMed Central  Google Scholar 

    85. Chokesuwattanaskul R, et al. Incidence of atrial fibrillation in pregnancy and clinical significance: a meta-analysis. Adv Med Sci. 2019;64(2):415–22.

      Article  PubMed  Google Scholar 

    86. Fuller BS, Voeltz MD. Clinical updates in women’s health care summary: arrhythmias: primary and preventive care review. Obstet Gynecol. 2017;129(5):969.

      Article  PubMed  Google Scholar 

    87. Cacciotti L, Passaseo I. Management of atrial fibrillation in pregnancy. J Atr Fibrillation. 2010;3(3):295.

      PubMed  PubMed Central  Google Scholar 

    88. Trahan MJ, et al. Management of new-onset atrial fibrillation in pregnancy: when should early delivery be considered? J Obstet Gynaecol Can. 2020;42(8):1012–5.

      Article  PubMed  Google Scholar 

    89. Widerhorn J, et al. Fetal and neonatal adverse effects profile of amiodarone treatment during pregnancy. Am Heart J. 1991;122(4 Pt 1):1162–6.

      Article  CAS  PubMed  Google Scholar 

    90. Georgiopoulos G, et al. Pharmacotherapeutic strategies for atrial fibrillation in pregnancy. Expert Opin Pharmacother. 2019;20(13):1625–36.

      Article  CAS  PubMed  Google Scholar 

    91. Ibetoh CN, et al. Supraventricular tachycardia in pregnancy: gestational and labor differences in treatment. Cureus. 2021;13(10): e18479.

      PubMed  PubMed Central  Google Scholar 

    92. Francinetti A, et al. Pharmacological cardioversion of supraventricular tachycardia in pregnancy during continuous electrophysiological foetal monitoring: a case report. Eur Heart J Case Rep, 2022;6(6):ytac213.

    93. Lao TT. Pulmonary embolism in pregnancy and the puerperium. Best Pract Res Clin Obstet Gynaecol. 2022;85(Pt A):96–106.

      Article  PubMed  Google Scholar 

    94. Rybstein MD, DeSancho MT. Risk factors for and clinical management of venous thromboembolism during pregnancy. Clin Adv Hematol Oncol. 2019;17(7):396–404.

      PubMed  Google Scholar 

    95. Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543–603.

      Article  PubMed  Google Scholar 

    96. Nichols KM, Henkin S, Creager MA. Venous Thromboembolism associated with pregnancy: JACC focus seminar. J Am Coll Cardiol. 2020;76(18):2128–41.

      Article  PubMed  Google Scholar 

    97. Bulletins—Obstetrics, A.C.o.O.a.G.C.o.P., ACOG practice bulletin no. 196: thromboembolism in pregnancy. Obstet Gynecol, 2018;132(1): e1-e17.

    98. Marik PE, Plante LA. Venous thromboembolic disease and pregnancy. N Engl J Med. 2008;359(19):2025–33.

      Article  CAS  PubMed  Google Scholar 

    99. Franchini M. Haemostasis and pregnancy. Thromb Haemost. 2006;95(3):401–13.

      Article  CAS  PubMed  Google Scholar 

    100. Sultan AA, et al. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol. 2012;156(3):366–73.

      Article  PubMed  Google Scholar 

    101. Larsen TB, et al. Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thromb Res. 2007;120(4):505–9.

      Article  CAS  PubMed  Google Scholar 

    102. Dado CD, Levinson AT, Bourjeily G. Pregnancy and pulmonary embolism. Clin Chest Med. 2018;39(3):525–37.

      Article  PubMed  PubMed Central  Google Scholar 

    103. van der Pol LM, et al. Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism. N Engl J Med. 2019;380(12):1139–49.

      Article  PubMed  Google Scholar 

    104. Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008;358(10):1037–52.

      Article  CAS  PubMed  Google Scholar 

    105. American College of O and B-O Gynecologists' Committee on Practice, ACOG practice bulletin no. 196: thromboembolism in pregnancy. Obstet Gynecol, 2018;132(1):e1-e17.

    106. Hall JG, Pauli RM, Wilson KM. Maternal and fetal sequelae of anticoagulation during pregnancy. Am J Med. 1980;68(1):122–40.

      Article  CAS  PubMed  Google Scholar 

    107. Dempfle CE. Minor transplacental passage of fondaparinux in vivo. N Engl J Med. 2004;350(18):1914–5.

      Article  CAS  PubMed  Google Scholar 

    108. Bates SM, et al. Guidance for the treatment and prevention of obstetric-associated venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):92–128.

      Article  CAS  PubMed  PubMed Central  Google Scholar 

    109. Middleton P, Shepherd E, Gomersall JC. Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period. Cochrane Database Syst Rev, 2021;3(3):CD001689.

    110. Bates SM, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018;2(22):3317–59.

      Article  CAS  PubMed  PubMed Central  Google Scholar 

    111. Bushnell C, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(5):1545–88.

      Article  PubMed  PubMed Central  Google Scholar 

    112. Too G, et al. Timing and risk factors of postpartum stroke. Obstet Gynecol. 2018;131(1):70–8.

      Article  PubMed  PubMed Central  Google Scholar 

    113. Swartz RH, et al. The incidence of pregnancy-related stroke: a systematic review and meta-analysis. Int J Stroke. 2017;12(7):687–97.

      Article  PubMed  Google Scholar 

    114. Kittner SJ, et al. Pregnancy and the risk of stroke. N Engl J Med. 1996;335(11):768–74.

      Article  CAS  PubMed  PubMed Central  Google Scholar 

    115. Tettenborn B. Stroke and pregnancy. Neurol Clin. 2012;30(3):913–24.

      Article  PubMed  Google Scholar 

    116. Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am J Obstet Gynecol. 2022;226(2S):S876–85.

      Article  PubMed  Google Scholar 

    117. Economy KE, Valente AM. Mechanical heart valves in pregnancy: a sticky business. Circulation. 2015;132(2):79–81.

      Article  PubMed  Google Scholar 

    118. Kleindorfer DO, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364–467.

      Article  PubMed  Google Scholar 

    119. Wabnitz A, Bushnell C. Migraine, cardiovascular disease, and stroke during pregnancy: systematic review of the literature. Cephalalgia. 2015;35(2):132–9.

      Article  PubMed  Google Scholar 

    120. Mayama M, et al. Incidence of posterior reversible encephalopathy syndrome in eclamptic and patients with preeclampsia with neurologic symptoms. Am J Obstet Gynecol. 2016;215(2):239.e1-5.

      Article  PubMed  Google Scholar 

    121. Razmara A, et al. Cerebrovascular complications of pregnancy and the postpartum period. Curr Cardiol Rep. 2014;16(10):532.

      Article  PubMed  Google Scholar 

    122. Committee Opinion No. 723: Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):e210–6.

      Article  Google Scholar 

    123. Landais A, Chaumont H, Dellis R. Thrombolytic therapy of acute ischemic stroke during early pregnancy. J Stroke Cerebrovasc Dis. 2018;27(2):e20–3.

      Article  PubMed  Google Scholar 

    124. Tversky S, et al. Thrombolysis for ischemic stroke during pregnancy: a case report and review of the literature. J Stroke Cerebrovasc Dis. 2016;25(10):e167–70.

      Article  PubMed  Google Scholar 

    125. Powers WJ, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–110.

      Article  PubMed  Google Scholar 

    126. Miller EC, Leffert L. Stroke in pregnancy: a focused update. Anesth Analg. 2020;130(4):1085–96.

      Article  PubMed  PubMed Central  Google Scholar 

    127. Chang JC, et al. Perinatal outcomes after statin exposure during pregnancy. JAMA Netw Open. 2021;4(12): e2141321.

      Article  PubMed  PubMed Central  Google Scholar 

    128. Cauldwell M, Rudd A, Nelson-Piercy C. Management of stroke and pregnancy. Eur Stroke J. 2018;3(3):227–36.

      Article  PubMed  PubMed Central  Google Scholar 

    129. Lamy C, et al. Ischemic stroke in young women: risk of recurrence during subsequent pregnancies.French Study Group on Stroke in Pregnancy. Neurology, 2000;55(2):269–74.

    130. Cruz-Herranz A, et al. Recurrence of stroke amongst women of reproductive age: impact of and on subsequent pregnancies. Eur J Neurol. 2015;22(4):681-e42.

      Article  CAS  PubMed  Google Scholar 

    131. Bulletins—Obstetrics, A.C.o.O.a.G.C.o.P. ACOG practice bulletin no. 203: chronic hypertension in pregnancy. Obstet Gynecol, 2019;133(1):e26-e50.

    132. Christopher BA, Pagidipati NJ. Clinical updates in women’s health care summary: evaluation and management of lipid disorders: primary and preventive care review. Obstet Gynecol. 2019;133(3):609.

      Article  PubMed  Google Scholar 

    133. Drugs and Lactation Database (LactMed®). 2006.

    Download references

    Author information

    Authors and Affiliations

    1. Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA

      Avisha Shah MD, Jay Patel DO & Ameesh Isath MD

    2. Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

      Hafeez Ul Hassan Virk MD

    3. Division of Cardiology, University of Texas Medical Branch, Houston, USA

      Hani Jneid MD

    4. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Valley Hospital, Ridgewood, NJ, USA

      Carolyn M. Zelop MD

    5. Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA

      Carolyn M. Zelop MD

    6. Department of Obstetrics and Gynecology, NYU Grossman School of Medicine, Ridgewood, NJ, USA

      Shilpi Mehta-Lee MD

    7. Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

      Katherine E. Economy MD

    8. Cedars-Sinai Medical Center, Barbra Streisand Women’s Heart Center, Smidt Heart Institute, Los Angeles, CA, USA

      Martha Gulati MD

    9. Cardiology Division, NYU Langone Health and NYU School of Medicine, 550 First Avenue, New York, NY, 10016, USA

      Chayakrit Krittanawong MD

    Authors
    1. Avisha Shah MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Jay Patel DO
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Ameesh Isath MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Hafeez Ul Hassan Virk MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Hani Jneid MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Carolyn M. Zelop MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Shilpi Mehta-Lee MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Katherine E. Economy MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Martha Gulati MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Chayakrit Krittanawong MD
      View author publications

      You can also search for this author in PubMed Google Scholar

    Contributions

    All authors had access to the data, contributed significantly to the work, and had a role in writing the manuscript.

    Corresponding author

    Correspondence to Chayakrit Krittanawong MD.

    Ethics declarations

    Conflict of Interest

    Dr. Zelop is a consultant for UpToDate as an author for CA during pregnancy. Other authors have no disclosure.

    Human and Animal Rights and Informed Consent

    This article does not contain any studies with human or animal subjects performed by any of the authors.

    Additional information

    Publisher's Note

    Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

    Rights and permissions

    Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Shah, A., Patel, J., Isath, A. et al. Cardiovascular Complications in Pregnancy. Curr Treat Options Cardio Med 25, 391–414 (2023). https://doi.org/10.1007/s11936-023-01000-8

    Download citation

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s11936-023-01000-8

    Keywords

    Search

    Navigation