Pregnancy ups heart attack risk

"It's extremely important that physicians who take care of women during pregnancy and after delivery be aware of the occasional occurrence of (a heart attack) in pregnancy and not overlook symptoms in these young patients," Dr Uri Elkayam said in a statement.

Elkayam, at the USC Keck School of Medicine in Los Angeles, and Dr Arie Roth, at the Sackler School of Medicine in Tel Aviv, Israel, reviewed data on 95 women with pregnancy-related heart attacks, along with the records of eight of their own such patients.

The heart attacks occurred at all stages of pregnancy and during the 3-month period after delivery, and were more frequent in women who had multiple pregnancies and those older than 30 years, the investigators report in the Journal of the American College of Cardiology.

Mortality rates were 11 percent in the mothers and nine percent among the unborn babies.

Difficult to identify women who are at risk
The causes of the heart attacks were plaque buildup in a coronary artery in 41 cases and a blood clot in eight. In 28 women, however, the cause was a normally rare occurrence - tearing of a coronary artery.

Trying to identify pregnant women who are at risk for a heart attack can be tricky. If exercise testing is used during pregnancy, the authors recommend a submaximal approach, with monitoring of the foetus. Also, they say, x-rays and other tests using radiation should be kept to a minimum.

If a woman is found to have narrowed coronary arteries and an unblocking procedure is considered, stents that release drugs should be avoided, and angioplasty is generally preferred over clot-busting drug treatment.

Also, the researchers advise, the risks of taking a cholesterol-lowering statin for pregnant women clearly outweigh any possible benefit.

Only 10 women in this study had cesarean deliveries, suggesting that, once a pregnant woman is stabilised after suffering a heart attack, "vaginal delivery can be accomplished relatively safely." – (Reuters Health)

July 2008

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