Lameijer, H. (Heleen) (2012) Coronary artery disease preceding and during pregnancy. thesis, Medicine.
Full text available on request.Abstract
Introduction: Little is known about coronary artery disease (CAD) preceding and during pregnancy. Management decisions are largely based on experts’ opinion, and so is counseling. With increasing maternal age, changing lifestyle and therefore a higher incidence of cardiac risk factors, more pregnant women will suffer from CAD. Methods We reviewed the literature about CAD preceding and during pregnancy and the postpartum period according to the PRISMA-statement protocol and searched the databases in three university hospitals in the Netherlands for a retrospective cohort study concerning CAD and pregnancy. Results: We included a total of 113 cases in our systematic review. All women in whom CAD preceded pregnancy had risk factors for CAD, mostly smoking. CAD was mainly due to atherosclerosis. Most were treated with PCI of CABG. Delivery was mainly performed by C-section, more than half of the neonates were prematurely delivered but did well. All women survived, without complications in follow-up. Most women in whom CAD first manifested during pregnancy had risk factors for CAD, mostly smoking. Most women were multiparous and were older compared to average pregnancy age. Most cases of CAD manifested in the 3th trimester or postpartum period. The main cause was coronary dissection. A minority suffered complications during pregnancy. Forty-four percent of the neonates were delivered prematurely, most were delivered by C-section. Neonates did well. Maternal mortality rate was 8,3 percent, almost 20 percent suffered complications in follow-up. In our retrospective cohort study we found ten cases of CAD preceding pregnancy. Almost all women smoked, had positive family history and thrombophilia was found in three out of eight women. Most women were older than average pregnancy age. During pregnancy, no cardiac complications were reported. Most deliveries were vaginal. Pregnancy resulted in eight life-born neonates of whom one was prematurely delivered. Almost all neonates had birth weight above p50 for gestational age. All women survived, one woman had cardiac complications in follow-up. We found two cases of CAD during pregnancy and the postpartum period. Both women survived CAD during pregnancy. Conclusion: Pregnancy complicated by pre-existing CAD has conflicting neonatal and maternal outcomes. In our review two out of twenty women had cardiac complications during pregnancy and more than half the neonates were prematurely delivered. However, we found less prematurity in our retrospective cohort study and good maternal outcome is suggested in these cases. Therefore, the common habit of advising women with pre-existing CAD against pregnancy should be reconsidered. CAD during pregnancy or in the postpartum period mainly presents during the third trimester or the postpartum period and is mainly due to coronary dissection. It has high maternal mortality rates and high maternal cardiac complication rate during follow-up. Premature delivery rate is high, but neonates do well. Risk factors for CAD during pregnancy or in the postpartum period are identified and mostly modifiable (e.g. smoking). Pregnant women at risk should be stimulated to modify their risk factors. Overall, more information is needed for better conclusions about final maternal outcome.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor of the Faculty and Pieper, Dr. P.G. cardiologist. and University Medical Centre Groningen. and Department of Cardiology, Cardiology Research Centre |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:45 |
| Last Modified: | 25 Jun 2020 10:45 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/669 |
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