What doe you mean with CVD?

CVD means cardiovascular diseases

May be if there is any effect is due to anesthesia or the indications e.g. preeeclampsia

What's the biological plausibility?

Hi I would like to comment that Patients with congenital aortic valve stenosis have increased risk of congenital heart disease in the fetus of 4% ; these patients may benefit from fetal echocardiography at 20-22 weeks. ... Ideally, women with symptomatic aortic stenosis should have surgical intervention prior to pregnancy. During pregnancy, your blood volume increases by 30 to 50 percent to nourish your growing baby, your heart pumps more blood each minute and your heart rate increases. During labor — particularly when you push — you'll have abrupt changes in blood flow and pressure. Peripartum cardiomyopathy is a rare type of heart failure. It occurs during pregnancy or immediately after delivery. The condition weakens the heart muscle and causes the heart to become enlarged. As a result, the heart can't pump blood properly to the rest of the body. A congenital heart defect (CHD) is a heart problem which is present at birth. It is caused by abnormal formation of the heart during fetal development. In most cases, when a baby is born with congenital heart disease, there is no known reason for it.

An increased prevalence of cardiovascular disease (CVD) has been found in women of childbearing age, with the presence of CVD in pregnant women posing a difficult clinical scenario in which the responsibility of the treating physician extends to the unborn fetus. Profound changes occur in the maternal circulation that have the potential to adversely affect maternal and fetal health, especially in the presence of underlying heart conditions. Up to 4% of pregnancies may have cardiovascular complications despite no known prior disease.

The European Society of Cardiology has published guidelines on the management of cardiovascular disease during pregnancy.

Prosthetic Heart Valves:

Anticoagulation for mechanical heart valves should be adjusted, because warfarin must be discontinued during the 1st trimester due to the well-documented risk of embryopathy. Current guidelines support 3 approaches: 1) low-molecular-weight (LMW) heparin administered subcutaneously twice daily throughout pregnancy, 2) unfractionated heparin administered subcutaneously twice daily throughout pregnancy, or 3) unfractionated or LMW heparin administered subcutaneously twice daily until gestational week 13, followed by warfarin from weeks 13 to 35, followed by a return to unfractionated or LMW heparin administered subcutaneously twice daily until delivery. Individual management approaches should be discussed jointly by the cardiologist, obstetrician, and patient. Aspirin for bioprosthetic heart valves is safe in pregnancy and need not be adjusted. Antibiotic prophylaxis for delivery (vaginal or caesarean section) is not recommended by the 2008 American Heart Association/American Dental Association guidelines. However, some obstetricians still routinely administer antibiotic agents at the time of rupture of membranes.

Acquired Heart Disease:

Acute coronary syndromes and myocardial infarction are rare in pregnancy (1–2 per 35,000 deliveries) but can occur in all stages. The usual coronary risk factors apply, and additional risk factors include advanced maternal age, thrombocytosis, blood transfusion, and preeclampsia. Cardiac catheterization is permissible in pregnant patients, with appropriate abdominal lead coverage for the mother and fluoroscopy time minimized. Thrombolytic agents can be given, but the guidelines for percutaneous coronary intervention should be followed. Direct-current cardioversion is also safe in pregnancy. Supraventricular and ventricular tachycardia should be treated by both nonpharmacologic and pharmacologic means, as in the nonpregnant patient. However, amiodarone should be avoided, because it crosses the placenta and can have toxic effects on the fetus. The indications for a permanent pacemaker follow the standard guidelines. The need to implant a cardiac defibrillator should be weighed against the need to delay this procedure until after delivery.

Congenital Heart Disease:

Several recent studies have addressed congenital heart disease (CHD) in pregnancy. In general, regurgitant lesions are well tolerated, whereas obstructive lesions are poorly tolerated. One well-cited retrospective study4 found no maternal deaths during analysis of 90 pregnancies in mothers who had CHD. However, 17% had pulmonary edema and 12% had cardiac events (most frequently a nonsustained tachyarrhythmia). A recent meta-analysis of 2,491 pregnancies in patients with CHD5 showed a miscarriage rate of 15% and a lower cardiovascular event rate of 6%. This study also found an 8% incidence of congenital heart disease in the offspring, which is similar to the findings of other studies.

The Cardiac Disease in Pregnancy (CARPREG) Risk Score (Table I) can be calculated to estimate a woman's cardiac risk during pregnancy.6 One point is assigned for each of the following risk factors: a history of cardiac event or arrhythmia, New York Heart Association functional class greater than II or cyanosis, left-heart obstruction (mitral valve area 4 cm), pulmonary hypertension (pulmonary vascular resistance, >6 Wood units), moderate-to-severe left ventricular outflow tract obstruction (≥30 mmHg), and LVEF < 0.30. If a woman with one of these conditions becomes pregnant, early consultation with a maternal-fetal medicine specialist and a cardiologist should be done in order to evaluate the patient's risk and develop the plan of care. Pregnancy with pulmonary hypertension confers a prohibitively high cardiac risk and carries a combined maternal and fetal mortality rate that approaches 50%. Termination of pregnancy should be considered in this condition.

Peripartum Cardiomyopathy:

Peripartum cardiomyopathy is defined as a dilated cardiomyopathy with congestive heart failure within the last month of pregnancy or within 5 months of delivery. This condition occurs at a rate of 1 in 2,289 live births and risk factors are multiparity, advanced maternal age, preeclampsia, gestational hypertension, and African descent. Some studies show a 75% recovery rate to normal ventricular function. Animal studies have suggested that a prolactin metabolite associated with peripartum cardiomyopathy can be cardiotoxic and that treatment with bromocriptine may be beneficial. Although the cause is not well understood, the treatment remains similar to that for congestive heart failure patients in general.

So I would conclude that Successful pregnancies can be achieved when cardiac complications are managed during pregnancy. In order to optimize maternal and neonatal outcomes, close collaboration between the maternal-fetal medicine specialist and the cardiologist is important. Regards