Coronary artery disease
Coronary artery disease is an important cause of mortality accounting for up to 20% of maternal
cardiac deaths in the most recent UK data [1]. Morbidity is more difficult to measure with data from the
UK Obstetric Surveillance System (OSS) study reporting an incidence of 0.7 per 100,000 pregnancies,
but this may be an underestimate as data are only collected up to 1 week post partum [20]. Older
studies using a review of discharge coding data reported an incidence of 6.2 acute myocardial infarctions
during pregnancy per 100,000 pregnancies [21]. In the UK data, all of the women who died
had at least one risk factor for coronary artery disease. Spontaneous coronary artery dissection is also
more common during the latter stages of pregnancy and post-partum period than in non-pregnant
women. Patients who are known to have coronary artery disease prior to pregnancy should undergo
complete cardiology review and risk stratification, and if there is inducible ischaemia, this should
preferably be treated prior to pregnancy.