2019 ACOG 实践简报：妊娠与心脏病（ No .212）.pdf

ACOG PRACTICE BULLETIN Clinical Management Guidelines for Obstetrician–Gynecologists NUMBER 212 Presidential Task Force on Pregnancy and Heart Disease Committee on Practice Bulletins—Obstetrics. This Practice Bulletin was developed by the American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Obstetrics in collaboration with the Presidential Task Force on Pregnancy and Heart Disease members Lisa M. Hollier, MD, James N. Martin Jr., MD, Heidi Connolly, MD, Mark Turrentine, MD, Afshan Hameed, MD, Katherine W. Arendt, MD, Octavia Cannon, DO, Lastascia Coleman, ARNP, CNM, Uri Elkayam, MD, Anthony Gregg, MD, MBA, Alison Haddock, MD, Stacy M. Higgins, MD, FACP, Sue Kendig, JD, Robyn Liu, MD, MPH, FAAFP, Stephanie R. Martin, DO, Dennis McNamara, MD, Wanda Nicholson, MD, Patrick S. Ramsey, MD, MSPH, Laura Riley, MD, Elizabeth Rochin, PhD, RN, NE- BC, Stacey E. Rosen, MD, Rachel G. Sinkey, MD, Graeme Smith, MD, PhD, Calondra Tibbs, MPH, Eleni Z. Tsigas, Rachel Villanueva, MD, Janet Wei, MD, and Carolyn Zelop, MD. Pregnancy and Heart Disease Maternal heart disease has emerged as a major threat to safe motherhood and women ’s long-term cardiovascular health. In the United States, disease and dysfunction of the heart and vascular system as “cardiovascular disease ” is now the leading cause of death in pregnant women and women in the postpartum period (1, 2) accounting for 4.23 deaths per 100,000 live births, a rate almost twice that of the United Kingdom (3, 4). The most recent data indicate that cardiovascular diseases constitute 26.5% of U.S. pregnancy-related deaths (5). Of further concern are the disparities in cardiovascular disease outcomes, with higher rates of morbidity and mortality among nonwhite and lower-income women. Contributing factors include barriers to prepregnancy cardiovascular disease assessment, missed opportuni- ties to identify cardiovascular disease risk factors dur