Cardiac disease in pregnancy and drug therapy

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Cardiac disease in pregnancy Microchapters

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Cardiovascular Drugs in Pregnancy

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Resuscitation in Late Pregnancy

Contraindications to pregnancy

Special Scenarios:

I. Pre-existing Cardiac Disease:
Congenital Heart Disease
Repaired Congenital Heart Disease
Pulmonary Hypertension
Rheumatic Heart Disease
Connective Tissue Disorders
II. Valvular Heart Disease:
Mitral Stenosis
Mitral Regurgitation
Aortic Insufficiency
Aortic Stenosis
Mechanical Prosthetic Valves
Tissue Prosthetic Valves
III. Cardiomyopathy:
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Peripartum Cardiomyopathy
IV. Cardiac diseases that may develop During Pregnancy:
Arrhythmias
Acute Myocardial Infarction
Hypertension

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

ACE inhibitors, Angiotensin receptor blockers (ARBss), aldosterone antagonists and warfarin should be avoided in pregnancy.

Cardiovascular Drugs that are Contraindicated During Pregnancy

Cardiovascular Drugs to be Avoided or Used with Caution During Pregnancy

  • Greatest experience in massive pulmonary embolism
  • Streptokinase does not cross placental membrane in animals, but Ab found in neonatal spinal cord fluid
  • Urokinase not teratogenic in mice/rats
  • Risk for maternal hemorrhage (1 case of placental abruption reported); increased risk when given at time of delivery
  • Delivery best delayed at least 2-3 weeks
  • Warfarin is teratogenic but is often required in patients with a mechanical heart valve during pregnancy. There is an increased magnitude of anticoagulation in the fetus compared with the mother because the synthesis of vitamin K dependent co-factors is reduced in the fetal liver. The risks of warfarin use should be discussed with the parents and include retroplacental bleeding, intracranial bleeding in the fetus, fetal loss, and premature birth. Warfarin is a better choice for the mother as it reduces the risk of fatal prosthetic valve thrombosis, but is not safe for the fetus for the reasons listed above. The risk of embryopathy (4%-10%) is highest with exposure from weeks 6 to 12, and is increased as the dose of warfarin is increased above 5 mg.

Cardiovascular Drugs that are Acceptable During Pregnancy

References

  1. Eliahou HE, Silverberg DS, Reisin E, Romem I, Mashiach S, Serr DM. Propranolol for the treatment of hypertension in pregnancy. Br J Obstet Gynaecol 1978;85:431-6.
  2. Lydakis C, Lip GY, Beevers M, Beevers DG. Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens 1999; 12:541-7.


Cardiology