Aortic disease in pregnancy

Over the last 17 years, Northside Hospital has hosted a multispecialty conference on cardio-obstetrics called The Heart of the Matter. The speakers for this conference included world experts along with Northside Hospital specialists.

This last spring, the conference included my presentation on aortic disease in pregnancy. Some of the emphasis of this topic was identifying obstetric patients with known aortic disease or at risk and determining possible preventative strategies. Although aortic dissection is rare, the risk is heightened in pregnancy, and patient counseling regarding the risk — along with birth control, medications, imaging, prophylactic surgery and labor management — is necessary.

It is estimated that nearly 20% of patients with thoracic aortic aneurysm and dissection (TAAD) syndrome have a family history of the disease. There are two categories of heritable thoracic aortic disease: syndromic disorders (part of a genetic syndrome, usually with other identifiable physical abnormalities) and non-syndromic disorders.

One of the most quoted guides to risk stratification in pregnancy is the modified World Health Organization (mWHO) classification. It is a risk classification that identifies the risk of maternal complications a patient may face based on the type of cardiac diagnosis.¹ Although it was developed a few years ago and there have been changes in our knowledge base, it provides a good starting point for risk stratification. The cohorts consist of I, II, II-III, III and IV, where classification I poses no significant additional risk of morbidity and mortality compared to the general population, versus classification IV, where pregnancy is not recommended.

Patients with TAAD should receive multidisciplinary cardio-obstetrics counseling, continual cardio-obstetrics team monitoring throughout pregnancy and delivery, and aorta imaging peripartum to ensure optimal outcomes for both mother and baby.²

References: 

• I. M. van Hagen and J. W. Roos-Hesselink, “Pregnancy in Women with Cardiovascular Disease,” Heart 106, no. 23 (2020): 1853–61.
• D. Crousillat et al., “Cardio-Obstetrics: A Growing Need for Multidisciplinary Care,” Journal of the American College of Cardiology 82, no. 9 (2023): 817–27.