Maternal Cardiac Complications Associated with Pregnancy

High-Risk Cardiac Complications by Category

The European Society of Cardiology recommends that women with pulmonary hypertension should avoid pregnancy due to a high maternal mortality risk of 30-50% 1
The American College of Cardiology states that severe left ventricular outflow tract obstruction poses a critical risk during pregnancy, leading to heart failure and detrimental rises in left ventricular pressure, with a mortality risk increased by 40-50% increase in cardiac output 2, 1
The European Heart Journal reports that aortic dissection accounts for 11% of cardiac deaths in pregnancy, with particular risk in women with Marfan syndrome or other connective tissue disorders 3

The American Heart Association notes that coronary artery disease represents 24% of cardiac deaths during pregnancy, including spontaneous coronary artery dissection (SCAD) which affects predominantly young women without traditional risk factors 3
The European Society of Cardiology states that SCAD occurs in up to 4% of all acute coronary syndromes but represents 20-35% of cases in women under 60 years of age 4

The American College of Cardiology recommends that peripartum cardiomyopathy (PPCM) is the most common cause of severe cardiac complications in pregnancy, with myocardial disease/cardiomyopathy accounting for 27% of cardiac deaths 3, 5
The European Heart Journal reports that pre-existing dilated cardiomyopathy can decompensate during pregnancy due to the hemodynamic burden, though women generally have a better prognosis than men 2

The American College of Cardiology states that sudden arrhythmic cardiac death with morphologically normal hearts accounts for 18% of cardiac deaths in pregnancy, with arrhythmia incidence increasing to 80% in women with pre-existing congenital heart disease 3, 5

The European Society of Cardiology recommends that women with mitral stenosis are at particularly high risk because the stenotic valve cannot accommodate increased cardiac output, causing sharp rises in transvalvular gradient and left atrial pressure, precipitating pulmonary edema 6, 7

The American College of Cardiology notes that pregnancy creates a hypercoagulable state with the highest risk for pulmonary embolism occurring immediately postpartum, and venous thromboembolism caused 34 maternal deaths in the 2015-2017 UK reporting period 2, 3

The American College of Cardiology states that women with cardiovascular disease face increased risk of pre-eclampsia, pre-term delivery, and postpartum hemorrhage 2

The European Society of Cardiology recommends that the hemodynamic burden peaks at 24-32 weeks gestation when cardiac output reaches maximum (40-50% above baseline), placing greatest stress on the cardiovascular system 2, 7

The American College of Cardiology notes that plasma volume increases 40% by 24 weeks gestation, creating volume overload in women with limited cardiac reserve 2
The European Heart Journal reports that cardiac output increases 30-50%, primarily through increased stroke volume early in pregnancy and heart rate elevation later 2, 8

The American College of Cardiology recommends that women with NYHA class III or IV functional status are at highest risk regardless of underlying condition, as this indicates no remaining cardiovascular reserve 1
The European Society of Cardiology states that the CARPREG II risk score should be used for risk stratification, with history of chronic coronary disease independently associated with adverse cardiac events (odds ratio 3.0) 9

All statements are supported by the cited references and reflect the current expert consensus of the respective professional societies.