pregnancy and congenital heart disease management

There was a new guideline from the American Heart Association on the management of congenital heart disease in pregnancy (see pregnancy and congenital heart disease circ2017 in dropbox, or DOI: 10.1161/CIR.0000000000000458, or go to URL: http://circ.ahajournals.org/content/early/2017/01/12/CIR.0000000000000458?sid=3d46cd93-3125-4db0-8f6c-a1002093e09d  ). Given that this is not a common primary care issue, i will broadly review their approach and defer to the article itself for the specifics 

in (very) brief, this article has sections on:

--physiology of pregnancy and its effects on the heart/lungs (eg increased blood volume, increased cardiac output, decreased oncotic pressure, increased heart rate, increased B-type natriuretic peptide, vascular tree remodeling to accommodate the increased blood volume, increased pulmonary tidal volume/minute ventilation)

--preconception counseling/diagnostic evaluation

--estimating maternal and fetal risk, including some risk stratification calculators

--medications in pregnancy (with detailed chart on cardiac meds, pregnancy risk category, teratogenic risk, lactation suggestions, etc)

--fetal screening

--approach to obstetric care

--therapy for cardiac problems (arrhythmias, heart block, mechanical valves/anticoagulation, heart failure, cyanosis)

--interventional therapies (transcatheter interventions, cardiovascular surgery, cardioversion, ablation, implantable defibrillators/pacemakers)

--specific cardiac conditions (pulmonary hypertension, aortic stenosis/LV outlet tract obstruction, transposition of great arteries, etc)

it seems to be a good reference to keep on hand for those of us doing prenatal care, or general medical care of women with congenital heart disease who are thinking of becoming pregnant