Cardiac disease in pregnancy epidemiology and demographics

Overview

 * Cardiovascular diseases, including heart disease and stroke, account for more than one-third (33.6%) of all U.S. deaths.


 * Approximately 1-4% of pregnancies in the United States involve maternal cardiovascular disease.


 * Heart disease along with deep venous thrombosis and pulmonary thromboembolism has surpassed hemorrhage, hypertensive disorders and infection as the leading cause of maternal mortality.

Epidemiology in Developed and Developing Countries

 * Increasing numbers of women with congenital heart disease are now reaching childbearing age.
 * Congential heart disease is now the most common form of heart disease complicating pregnancy in the United States.
 * Rheumatic heart disease still predominates in developing countries and in immigrant populations in the United States.
 * Maternal death during pregnancy in women with heart disease is rare; conditions that are associated with increased mortality include Eisenmenger syndrome, pulmonary vascular obstructive disease, and Marfan syndrome with aortopathy.
 * In a prospective study of 562 pregnant women with heart disease (aged 28 ± years) at 13 Canadian cardiac and obstetric teaching hospitals, a primary cardiac event occurred in 80 completed pregnancies (13%), the most common complications being pulmonary edema and cardiac arrhythmia.

Pregnancy-related Mortality in the United States

 * A pregnancy-related death is defined as the death of a woman while pregnant or within one year of pregnancy termination regardless of the duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.


 * In the United States—
 * Of the 3,319 deaths within a year of pregnancy termination that occurred in 2006-2007, 1,294 were found to be pregnancy-related.
 * The pregnancy-related mortality ratio was 15.1 deaths per 100,000 live births for the period 2006–2007.


 * Considerable racial disparities in pregnancy-related mortality exist and during the 2006–2007 period, the pregnancy-related mortality ratios were:
 * 11.0 deaths per 100,000 live births for white women.
 * 34.8 deaths per 100,000 live births for black women.
 * 15.7 deaths per 100,000 live births for women of other races.


 * The graph below depicts the causes for pregnancy-related deaths in the United States for the year 2006-2007.



Resources

 * CDC: Pregnancy-related Mortality in the United States, 2006-2007
 * CDC: Pregnancy-related mortality in the United States, 1998–2005


 * CDC: Pregnancy-related mortality in the United States, 1991–1997


 * CDC: Pregnancy-related mortality in the United States, 1987–1990.