CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2018; 78(12): 1256-1261
DOI: 10.1055/a-0774-8696
GebFra Science
Review/Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Cardiomyopathies and Congenital Heart Disease in Pregnancy

Article in several languages: English | deutsch
Mechthild Westhoff-Bleck
1  Medizinische Hochschule Hannover, Molekulare Kardiologie, Abteilung für Kardiologie und Angiologie, Hannover, Germany
,
Denise Hilfiker-Kleiner
1  Medizinische Hochschule Hannover, Molekulare Kardiologie, Abteilung für Kardiologie und Angiologie, Hannover, Germany
,
Sabine Pankuweit
2  Klinik für Innere Medizin, Kardiologie, Angiologie und internistische Intensivmedizin, Klinikum der Philipps-Universität, Marburg, Germany
,
Bernhard Schieffer
2  Klinik für Innere Medizin, Kardiologie, Angiologie und internistische Intensivmedizin, Klinikum der Philipps-Universität, Marburg, Germany
› Author Affiliations
Further Information

Publication History

received 24 July 2018
revised 26 October 2018

accepted 27 October 2018

Publication Date:
14 December 2018 (online)

  

Abstract

Pregnancy-associated diseases of the cardiovascular system occur in up to 10% of all pregnancies and the incidence is increasing. Besides congenital heart disease or pre-existing cardiomyopathy in the mother, the clinical focus has moved especially to peripartum cardiomyopathy (PPCM) because of the conditionʼs dramatic clinical course and the identification of the underlying mechanisms. This review article concentrates therefore on PPCM, which occurs either in the last month of pregnancy or in the first 6 months following delivery in women with previously healthy hearts. The global incidence is estimated today at roughly 1 : 1000 pregnancies. The condition is heterogeneous, ranging from mild disease to severe acute heart failure with cardiogenic shock and sudden cardiac death of the mother. Important risk factors are pregnancy-associated hypertensive complications, multiple pregnancy and greater maternal age. The pathogenesis comprises cleavage, induced by increased oxidative stress, of the lactation hormone prolactin into a toxic hormone fragment that damages blood vessels, known as the 16-kDalton protein fragment. The lactation-blocking drug bromocriptine prevents prolactin release and promotes healing of PPCM in combination with pharmacological heart failure therapy; it appears to prevent recurrence in subsequent pregnancies. Uncomplicated pregnancy is possible in most patients with congenital heart disease. The foetal complications include an increased abortion rate, prematurity and smallness for gestational age, as well as an increased risk of cardiac malformations. The maternal risk comprises mainly arrhythmias, progressive heart failure and thrombembolic complications, with the risk of vessel dissection with a low mortality risk of < 1% in the case of aortopathies. Individual risk assessment and corresponding close monitoring of the pregnancy are required.