Is it safe for women with heart disease to become pregnant?

August 28, 2018

Munich, Germany - 28 Aug 2018: Is it safe for women with heart disease to become pregnant? Usually, according to ten-year results from the ROPAC registry1 reported in a late breaking science session today at ESC Congress 20182.

Professor Jolien Roos-Hesselink, one of the principal investigators, Erasmus Medical Centre, Rotterdam, the Netherlands, said: "Pregnancy is safe for most women with heart disease but for some it is too risky. Our study shows that fewer women with heart disease die or have heart failure during pregnancy than ten years ago. However, nearly one in ten women with pulmonary arterial hypertension died during pregnancy or early post-partum."

"Pre-pregnancy counselling is crucial to identify women who should be advised against pregnancy, initiate timely treatment - for instance in those with severe valvular heart disease, and to discuss the risks and options," she added.

Pregnancy has a major impact on the mother's circulation. The heart has to pump up to 50% more blood and heart rate rises by 10-20%, which can be risky in women with heart disease.

Heart disease is the top reason women die during pregnancy in developed countries. Worldwide, heart disease causes up to 15% of maternal deaths during pregnancy or in the early post-partum period. While other causes of maternal mortality such as blood loss or infection are declining, the burden of maternal heart disease is rising.

Today researchers present outcomes of 5,739 pregnant women with heart disease enrolled from 138 centres in 53 countries during 2007 to 2018. The average age of the mothers was 29.5 years and 45% had never delivered before.

More than half of the women (57%) had been born with a heart malformation (congenital heart disease), and the majority had surgical correction at a young age. Other diagnoses were valvular heart disease (29%), cardiomyopathy (8%), aortic disease (4%), ischaemic heart disease (2%), and pulmonary arterial hypertension (1%).

Professor Roos-Hesselink said: "The proportion of women with conditions considered very high risk by the World Health Organization increased from around 1% in 2007 to 10% in 2018. This suggests that more women with very high risk heart diseases are becoming pregnant than in the past. This is probably because corrective surgery has improved survival and more women reach reproductive age, and perhaps doctors are becoming more selective in who they advise to avoid pregnancy."

Overall, less than 1% of women died during pregnancy or the early post-partum period. Women with pulmonary arterial hypertension, meaning an abnormally high blood pressure in the lungs, had the highest rate of death (9%). Rates of foetal and neonatal death were both 1%.

Delivery was by caesarean section in 44% of the women, of which more than one-third were for cardiac reasons (16% of all deliveries). Regarding complications, heart failure, supraventricular and ventricular arrhythmias occurred in 11%, 2% and 2% of women, respectively. Women were more likely to have complications during pregnancy if they had any of the following prior to becoming pregnant: heart failure, diminished exercise capacity, decreased pump function of the heart (reduced ejection fraction), or use of anticoagulant medications.

Professor Roos-Hesselink said: "After an initial increase in maternal mortality and new diagnoses of heart failure during pregnancy between 2007 and 2010, these rates have been declining. This occurred despite the presence of more very high risk women with heart disease being included in our registry as time went by."

Professor Roos-Hesselink noted that the fall in adverse outcomes over the years might indicate greater awareness of the specific problems and better management of pregnant women with heart disease. The first ESC guidelines on the management of cardiovascular diseases during pregnancy were published in 2011, with a second edition in 2018.3
Notes to editors

SOURCES OF FUNDING: Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011-2014), Amgen Cardiovascular (2009-2018), AstraZeneca (2014-2017), Bayer AG (2009-2018), Boehringer Ingelheim (2009-2019), Boston Scientific (2009-2012), The Bristol Myers Squibb and Pfizer Alliance (2011-2019), Daiichi Sankyo Europe GmbH (2011-2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014-2017), Edwards (2016-2019), Gedeon Richter Plc. (2014-2016), Menarini Int. Op. (2009-2012), MSD-Merck & Co. (2011-2014), Novartis Pharma AG (2014-2017), ResMed (2014-2016), Sanofi (2009-2011), SERVIER (2009-2018).



1The Registry Of Pregnancy And Cardiac disease (ROPAC) is a worldwide, prospective registry which aims to gather reliable information on outcomes in women with structural or ischaemic heart disease and their babies. The registry was set up in 2007 by co-chairs Professor Roos-Hesselink and Professor Roger Hall of the University of East Anglia, Norwich, UK, and is part of the EURObservational Research Programme (EORP) of the ESC.

2"ROPAC - Pregnancy in women with cardiovascular disease: trends in outcome from 10 years ESC Registry of Pregnancy and Cardiac Disease" will be presented during the session Late Breaking Registry Results 2 on Tuesday 28 August from 14:30 to 15:45 CEST at the Centre Stage - The Hub.

32018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. European Heart Journal. 2018. doi: 10.1093/Eurheartj/ehy340.

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2018

ESC Congress is the world's largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2018 takes place 25 to 29 August at the Messe München in Munich, Germany. Explore the scientific programme.

More information is available from the ESC Press Office at

European Society of Cardiology

Related Heart Disease Articles from Brightsurf:

Cellular pathway of genetic heart disease similar to neurodegenerative disease
Research on a genetic heart disease has uncovered a new and unexpected mechanism for heart failure.

Mechanism linking gum disease to heart disease, other inflammatory conditions discovered
The link between periodontal (gum) disease and other inflammatory conditions such as heart disease and diabetes has long been established, but the mechanism behind that association has, until now, remained a mystery.

New 'atlas' of human heart cells first step toward precision treatments for heart disease
Scientists have for the first time documented all of the different cell types and genes expressed in the healthy human heart, in research published in the journal Nature.

With a heavy heart: How men and women develop heart disease differently
A new study by researchers from McGill University has uncovered that minerals causing aortic heart valve blockage in men and women are different, a discovery that could change how heart disease is diagnosed and treated.

Heart-healthy diets are naturally low in dietary cholesterol and can help to reduce the risk of heart disease and stroke
Eating a heart-healthy dietary pattern rich in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, vegetable oils and nuts, which is also limits salt, red and processed meats, refined-carbohydrates and added sugars, is relatively low in dietary cholesterol and supports healthy levels of artery-clogging LDL cholesterol.

Pacemakers can improve heart function in patients with chemotherapy-induced heart disease
Research has shown that treating chemotherapy-induced cardiomyopathy with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can significantly improve patient outcomes.

Arsenic in drinking water may change heart structure raising risk of heart disease
Drinking water that is contaminated with arsenic may lead to thickening of the heart's main pumping chamber in young adults, according to a new study by researchers at Columbia University Mailman School of Public Health.

New health calculator can help predict heart disease risk, estimate heart age
A new online health calculator can help people determine their risk of heart disease, as well as their heart age, accounting for sociodemographic factors such as ethnicity, sense of belonging and education, as well as health status and lifestyle behaviors.

Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure
Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.

Heart failure: The Alzheimer's disease of the heart?
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.

Read More: Heart Disease News and Heart Disease Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to