Guidelines of the Spanish Society of Cardiology for the management of cardiovascular diseases during pregnancy

Maternal adaptation to pregnancy includes reproductive hormone interaction plasma, volume changes with an increase in total body water, vascular alter ations with a decrease in systemic resistance and modifications associated with hypercoagulability. These explain, in part, the appearance of signs an d symptoms, even in a normal pregnant woman, that are difficult to distingu ish from those occurring in heart disease and why some cardiac abnormalitie s are not well tolerated during pregnancy. Cardiovascular abnormalities are considered the first non-obstetric cause o f morbidity and mortality during pregnancy. Rheumatic and congenital heart diseases are currently the most frequent cardiopathy found in women of chil dbearing age, followed by hypertension, coronary artery disease and arrhyth mia. Although pregnancy is well tolerated by most women with heart disease, ther e are some cardiovascular abnormalities which place the mother and the infa nt at extremely high risk: patients with congestive heart failure and sever e cardiac dysfunction, pulmonary hypertension, cyanotic congenital heart di sease, Marfan's syndrome, severe obstructive lesions of the left side of th e heart, patients with prosthetic cardiac valves and antecedents of peripar tum cardiomyopathy should be encouraged to avoid pregnancy and the interrup tion of pregnancy may be advisable in cases with great risk of disability o r death. The most severe cardiopathies significantly increase the risk of fetal loss and the presence of a congenital cardiac abnormality in either parent incr eases the risk of congenital cardiac disease in the fetus. Medical care mus t be initiated early, prior to conception and women with cardiopathy should be informed of the possible risks of pregnancy to both the mother and fetu s.