The burden of pre-existing cardiovascular disease and the contribution to adverse pregnancy outcomes are not robustly quantified, particularly in low-income countries. We aimed to determine both the prevalence of maternal heart disease through active case finding and its attributable risk to adverse pregnancy outcomes.

Reducing maternal mortality is a World Health Organization (WHO) global health goal. Although maternal deaths due to haemorrhage and infection are declining, those related to heart disease are increasing and are now the most important cause in western countries. The aim is to define contemporary diagnosis-specific outcomes in pregnant women with heart disease.From 2007 to 2018, pregnant women with heart disease were prospectively enrolled in the Registry Of Pregnancy And Cardiac disease (ROPAC). Primary outcome was maternal mortality or heart failure, secondary outcomes were other cardiac, obstetric, and foetal complications. We enrolled 5739 pregnancies; the mean age was 29.5. Prevalent diagnoses were congenital (57%) and valvular heart disease (29%). Mortality (overall 0.6%) was highest in the pulmonary arterial hypertension (PAH) group (9%). Heart failure occurred in 11%, arrhythmias in 2%. Delivery was by Caesarean section in 44%. Obstetric and foetal complications occurred in 17% and 21%, respectively. The number of high-risk pregnancies (mWHO Class IV) increased from 0.7% in 2007-2010 to 10.9% in 2015-2018. Determinants for maternal complications were pre-pregnancy heart failure or New York Heart Association >II, systemic ejection fraction <40%, mWHO Class 4, and anticoagulants use. After an increase from 2007 to 2009, complication rates fell from 13.2% in 2010 to 9.3% in 2017.Rates of maternal mortality or heart failure were high in women with heart disease. However, from 2010, these rates declined despite the inclusion of more high-risk pregnancies. Highest complication rates occurred in women with PAH.Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

To describe the outcome of pregnancy in patients with structural or ischaemic heart disease.In 2007, the European Registry on Pregnancy and Heart disease was initiated by the European Society of Cardiology. Consecutive patients with valvular heart disease, congenital heart disease, ischaemic heart disease (IHD), or cardiomyopathy (CMP) presenting with pregnancy were enrolled. Data for the normal population were derived from the literature. Sixty hospitals in 28 countries enrolled 1321 pregnant women between 2007 and 2011. Median maternal age was 30 years (range 16-53). Most patients were in NYHA class I (72%). Congenital heart disease (66%) was most prevalent, followed by valvular heart disease 25%, CMP 7%, and IHD in 2%. Maternal death occurred in 1%, compared with 0.007% in the normal population. Highest maternal mortality was found in patients with CMP. During pregnancy, 338 patients (26%) were hospitalized, 133 for heart failure. Caesarean section was performed in 41%. Foetal mortality occurred in 1.7% and neonatal mortality in 0.6%, both higher than in the normal population. Median duration of pregnancy was 38 weeks (range 24-42) and median birth weight 3010 g (range 300-4850). In centres of developing countries, maternal and foetal mortality was higher than in centres of developed countries (3.9 vs. 0.6%, P < 0.001 and 6.5 vs. 0.9% P < 0.001)The vast majority of patients can go safely through pregnancy and delivery as long as adequate pre-pregnancy evaluation and specialized high-quality care during pregnancy and delivery are available. Pregnancy outcomes were markedly worse in patients with CMP and in developing countries.

To analyze trends in the incidence, in-hospital management, and outcomes of acute myocardial infarction (AMI) complicating pregnancy and the puerperium in the United States.Women 18 years or older hospitalized during pregnancy and the puerperium were identified from the National Inpatient Sample database from January 1, 2002, to December 31, 2014. International Classification of Diseases, Ninth Revision diagnosis and procedure codes were used to identify AMI during pregnancy-related admissions.Overall, 55,402,290 pregnancy-related hospitalizations were identified. A total of 4471 cases of AMI (8.1 [95% CI, 7.5-8.6] cases per 100,000 hospitalizations) occurred, with 922 AMI cases (20.6%) identified in the antepartum period, 1061 (23.7%) during labor and delivery, and 2390 (53.5%) in the postpartum period. ST-segment elevation myocardial infarction occurred in 1895 cases (42.4%), and non-ST-segment elevation myocardial infarction occurred in 2576 cases (57.6%). Among patients with pregnancy-related AMI, 2373 (53.1%) underwent invasive management and 1120 (25.1%) underwent coronary revascularization. In-hospital mortality was significantly higher in patients with AMI than in those without AMI during pregnancy (adjusted odds ratio, 39.9; 95% CI, 23.3-68.4; P<.001). The rate of AMI during pregnancy and the puerperium increased over time (adjusted odds ratio, 1.25 [for 2014 vs 2002]; 95% CI, 1.02-1.52).In patients hospitalized during pregnancy and the puerperium, AMI occurred in 1 of every 12,400 hospitalizations and rates of AMI increased over time. Maternal mortality rates were high. Additional research on the prevention and optimal management of AMI during pregnancy is necessary.Copyright © 2018 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

To update national population-level pregnancy-related mortality estimates and examine characteristics and causes of pregnancy-related deaths in the United States during 2011–2013.

There has been an increase in maternal deaths from cardiovascular disease in many countries. In high income countries, cardiovascular deaths secondary to cardiomyopathies, ischemic heart disease, sudden arrhythmic deaths, aortic dissection, and valve disease are responsible for up to one third of all pregnancy-related maternal deaths. In low- and middle-income countries, rheumatic heart disease is a much more common cause of cardiac death during pregnancy. Although deaths occur in women with known heart conditions or cardiovascular risk factors such as hypertension, many women present for the first time in pregnancy with unrecognized heart disease or with de novo cardiovascular conditions such as preeclampsia, peripartum cardiomyopathy, spontaneous coronary artery dissection. Not only has maternal cardiovascular mortality increased, but serious cardiac morbidity, or 'near misses', during pregnancy have also increased in frequency. Although maternal morbidity and mortality are often preventable, many health care professionals remain unaware of the impact of cardiovascular disease in this population and the lack of awareness contributes to inappropriate care and preventable deaths. In this review, we discuss the maternal mortality from cardiovascular causes in both high and low and middle-income countries and strategies to improve outcomes.Copyright © 2021. Published by Elsevier Inc.

目的 分析北京市1995—2017年妊娠合并心脏病孕产妇死亡情况及死因,为降低孕产妇死亡率探索相应干预措施。方法 按照国家孕产妇死亡监测方法,收集北京市1994年10月1日—2017年9月30日妊娠合并心脏病孕产妇死亡资料64例进行分析。结果 1995—2017年北京市妊娠合并心脏病死亡率为1.9/10万,占孕产妇死亡总数的12.5%;死亡原因前三位分别为先天性心脏病(22例,占34.4%)、妊娠期高血压疾病性心脏病(14例,占21.9%)、围产期心肌病(7例,占10.9%);死亡影响因素前三位分别为医生知识技术水平欠缺(30例,占51.7%)、患者保健意识淡薄/依从性差(30例,占51.7%)、高危孕产妇管理不到位(22例,占37.9%)。结论 加强妊娠合并心脏病的认识及相关知识技能培训;加强高危孕产妇管理,保障院内及院间转会诊通道畅通;同时加大宣传教育力度,增加社会支持力量是降低妊娠合并心脏病孕产妇死亡的重要措施。

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 孕产妇死亡是指任何妊娠或妊娠相关的原因导致孕产妇从开始妊娠至产后42d内出现死亡（意外死亡的孕产妇不包括在内）。孕产妇死亡率是反映一个区域政治、经济、文化和卫生状况的重要指标。随着医疗技术水平的提高，国家卫生健康委员会发布《中国妇幼健康事业发展报告（2019）》，提示2018年全国孕产妇死亡率下降至18.3/10万。据统计，全国孕产妇死亡率最高的前4种疾病是产科出血（4.7/10万）、羊水栓塞（2.2/10万）、心脏病（2.0/10万）、妊娠期高血压疾病（1.6/10万）。2008&mdash;2017年上海危重孕产妇死亡64例，前2位死因分别为妊娠合并心脏病17例（26.15%）、重度子痫前期/子痫9例（13.85%）［1］，以上数据显示妊娠合并心脏病已成为孕产妇死亡的非产科因素首位因素。如何优化妊娠合并心脏病孕产妇的管理、降低孕产妇死亡率仍是需亟待完善的重要问题。浏览更多请关注本刊微信公众号及当期杂志。

The incidence of pregnancy in women with cardiovascular disease is rising, primarily due to the increased number of women with congenital heart disease reaching childbearing age and the changing demographics associated with advancing maternal age. Although most cardiac conditions are well tolerated during pregnancy and women can deliver safely with favorable outcomes, there are some cardiac conditions that have significant maternal and fetal morbidity and mortality. The purpose of this paper is to review the available published reports and provide recommendations on the management of women with high-risk cardiovascular conditions during pregnancy.Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.