Perspective:

Cardiovascular disease is a leading cause of maternal morbidity and mortality. In this well-defined cohort, pregnant women with heart disease were at increased risk for SCEs, and half of the adverse outcomes were preventable. The majority of the preventable events occurred due to provider management factors, including: failure to identify the condition prior to pregnancy, failure to identify the patient as high risk, late recognition in cardiac deterioration, delay in treatment/intervention, inappropriate treatment, and lack of preconception counseling. Preventable adverse events also occurred when patients failed to seek care, were noncompliant, or lacked access to health care. These findings suggest that provider training, patient education, and health care advocacy are all important interventions to improve outcomes among pregnant women. The development of multidisciplinary cardio-obstetric clinics at tertiary care centers may also be helpful.