The Present and Future
JACC State-of-the-Art Review
Use of Medication for Cardiovascular Disease During Pregnancy: JACC State-of-the-Art Review

https://doi.org/10.1016/j.jacc.2018.10.075Get rights and content
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Abstract

Cardiovascular disease complicating pregnancy is rising in prevalence secondary to advanced maternal age, cardiovascular risk factors, and the successful management of congenital heart disease conditions. The physiological changes of pregnancy may alter drug properties affecting both mother and fetus. Familiarity with both physiological and pharmacological attributes is key for the successful management of pregnant women with cardiac disease. This review summarizes the published data, available guidelines, and recommendations for use of cardiovascular medications during pregnancy. Care of the pregnant woman with cardiovascular disease requires a multidisciplinary team approach with members from cardiology, maternal fetal medicine, anesthesia, and nursing.

Key Words

cardiovascular medications
gestation
pharmacokinetics
pregnancy

Abbreviations and Acronyms

AAD
antiarrhythmic medication
ACE
angiotensin-converting enzyme
ACOG
American Congress of Obstetricians and Gynecologists
AF
atrial fibrillation
AMD
alpha-methyldopa
ARB
angiotensin receptor blocker
ARNi
angiotensin receptor–neprysilin inhibitor
BAV
bicuspid aortic valve
CCB
calcium channel blocker
CVD
cardiovascular disease
ER
extraction ratio
ESC
European Society of Cardiology
FC
functional class
FDA
Food and Drug Administration
HCTZ
hydrochlorothiazide
IUGR
intrauterine fetal growth restriction
LMWH
low molecular weight heparin
MFS
Marfan syndrome
PH
pulmonary hypertension
PLLR
Pregnancy and Lactation Labeling Rule
PPCM
peripartum cardiomyopathy
QTc
QT interval corrected for heart rate
RV
right ventricular
SVT
supraventricular tachycardia
Vd
volume of distribution
VKA
vitamin K antagonist
VT
ventricular tachycardia
WPW
Wolff-Parkinson-White

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The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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