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Management of Ischemic Heart Disease in Pregnancy

  • Women and Ischemic Heart Disease (J.M. Peña and F. Lin, Section Editors)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Cardiovascular disease is an escalating cause of maternal morbidity and mortality. Women are at risk for acute myocardial infarction (MI), and more are living with risk factors for ischemic heart disease (IHD). The purpose of this review is to describe the evaluation and management of women at risk for and diagnosed with IHD in pregnancy.

Recent Findings

Pregnancy can provoke MI which has been estimated as occurring in 1.5–10/100, 000 deliveries or 1/12,400 hospitalizations, with a high inpatient mortality rate of approximately 5–7%. An invasive strategy may or may not be preferred, but fetal radiation exposure is less of a concern in comparison to maternal mortality. Common medications used to treat IHD may be continued successfully during pregnancy and lactation, including aspirin, which has an emerging role in pregnancy to prevent preeclampsia, preterm labor, and maternal mortality. Hemodynamics can be modulated during pregnancy, labor, and postpartum to mitigate risk for acute decompensation in women with IHD.

Summary

Cardiologists can successfully manage IHD in pregnancy with obstetric partners and should engage women in a lifetime of cardiovascular care.

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Acknowledgments

AEB recognizes support from an American Heart Association Mentored and Clinical Population Research Award 17MCPRP33630098 and K23 HL146982 from the National Heart, Lung and Blood Institute (NHLBI). The authors thank Emmanuel Gee for assistance in preparing Figure 1a.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA

    Patricia Chavez, Diana Wolfe & Anna E. Bortnick

  2. Department of Obstetrics & Gynecology and Women’s Health (Maternal Fetal Medicine), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA

    Diana Wolfe

  3. Maternal Fetal Medicine & Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA

    Diana Wolfe & Anna E. Bortnick

  4. Division of Geriatrics, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA

    Anna E. Bortnick

  5. Jack D. Weiler Hospital, 1825 Eastchester Road Suite 2S-46 Bronx, New York, NY, 10461, USA

    Anna E. Bortnick

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  1. Patricia Chavez
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PC, DW, and AEB: manuscript writing, manuscript editing, and final approval of the manuscript.

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Correspondence to Anna E. Bortnick.

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The authors report no financial relationships or conflicts of interest regarding the content herein. AEB is a site PI for trials by Abbott, Inc. and CSL-Behring for which her institution receives compensation. AEB also reports honorarium from Clearview Healthcare Partners, LLC, and S2N Healthcare, LLC outside the submitted work.

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Chavez, P., Wolfe, D. & Bortnick, A.E. Management of Ischemic Heart Disease in Pregnancy. Curr Atheroscler Rep 23, 52 (2021). https://doi.org/10.1007/s11883-021-00944-1

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