Best Practice & Research Clinical Obstetrics and Gynaecology 28 (2014) 469

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Preface

Preface: Issue 28.4

Cardiac disease in pregnancy is important, and becoming increasingly so. It is the leading cause of maternal death in many developed countries. The severity of disease, the number of hospitalisations and the numbers dying have risen steadily over the past three decades, and there is little reason to expect any improvement in these trends for the foreseeable future. A number of major demographic shifts underlie these trends. The average age of the pregnant population has risen steadily in most developed countries. This means that not only is acquired heart disease more prevalent in pregnancy, but other related comorbidities such as hypertension, obesity and diabetes are more common too. As well as the rise in acquired heart disease, a growing cohort of women with congenital and inherited heart disease is now reaching adulthood and becoming pregnant for the first time. In the past, many would have died in infancy or childhood and those reaching adulthood were advised not to conceive. However, over time and with greater clinical experience, it is clear that the majority of women with heart disease can have a good pregnancy outcome. This is possible if they have access to expert multi-disciplinary team care, even when scientific date to support and management decisions are lacking. The myriad physiological changes of pregnancy have a major effect on cardiovascular function, and on the pharmacokinetics of many drugs used in the management of women with cardiac disease. And of course, there is the need to consider the risks of any drugs, and of the cardiac disease itself, on the fetus, the second patient in our care. So this is a fascinating and rapidly changing area of medicine. We hope that this issue of the Journal will bring the reader up to date with the latest management and treatment options for these patients, provided by leaders in the field. Pat O’Brien, MBBCh, FRCOG, FFSRH, FICOG, Consultant Obstetrician & Gynaecologist* Institute for Women’s Health, University College London Hospitals NHS Trust, London, UK Fiona Walker, BM (Hons), FRCP, FESC, Consultant Cardiologist, Service Lead Grown-up Congenital Heart Disease, Head of Maternal Cardiology The Heart Hospital, University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London, UK E-mail address: fi[email protected]  Corresponding author. E-mail address: [email protected]

http://dx.doi.org/10.1016/j.bpobgyn.2014.03.012 1521-6934/Ó 2014 Published by Elsevier Ltd.

Cardiac disease in pregnancy.

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