Team-Based Care of Women With Cardiovascular Disease From Pre-Conception Through Pregnancy and Postpartum: JACC Focus Seminar 1/5

The specialty of cardio-obstetrics has emerged in response to the rising rates of maternal morbidity and mortality related to cardiovascular disease (CVD) during pregnancy. Women of childbearing age with or at risk for CVD should receive appropriate counseling regarding maternal and fetal risks of p...

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Published in:Journal of the American College of Cardiology 2021-04, Vol.77 (14), p.1763-1777
Main Authors: Davis, Melinda B, Arendt, Katherine, Bello, Natalie A, Brown, Haywood, Briller, Joan, Epps, Kelly, Hollier, Lisa, Langen, Elizabeth, Park, Ki, Walsh, Mary Norine, Williams, Dominique, Wood, Malissa, Silversides, Candice K, Lindley, Kathryn J
Format: Article
Language:English
Subjects:
Cardiovascular Diseases - classification
Cardiovascular Diseases - physiopathology
Cardiovascular Diseases - therapy
Female
Heart Disease Risk Factors
Humans
Patient Care Team - organization & administration
Peripartum Period
Pregnancy
Pregnancy Complications, Cardiovascular - classification
Pregnancy Complications, Cardiovascular - physiopathology
Pregnancy Complications, Cardiovascular - therapy
Risk Adjustment - methods
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Summary:The specialty of cardio-obstetrics has emerged in response to the rising rates of maternal morbidity and mortality related to cardiovascular disease (CVD) during pregnancy. Women of childbearing age with or at risk for CVD should receive appropriate counseling regarding maternal and fetal risks of pregnancy, medical optimization, and contraception advice. A multidisciplinary cardio-obstetrics team should ensure appropriate monitoring during pregnancy, plan for labor and delivery, and ensure close follow-up during the postpartum period when CVD complications remain common. The hemodynamic changes throughout pregnancy and during labor and delivery should be considered with respect to the individual cardiac disease of the patient. The fourth trimester refers to the 12 weeks after delivery and is a key time to address contraception, mental health, cardiovascular risk factors, and identify any potential postpartum complications. Women with adverse pregnancy outcomes are at increased risk of long-term CVD and should receive appropriate education and longitudinal follow-up.
ISSN:1558-3597
DOI:10.1016/j.jacc.2021.02.033