The increase in the rate of maternal deaths related to cardiovascular disease in Japan from 1991-1992 to 2010-2012

Background: Cardiovascular diseases (CVD), both genetic and acquired, increase the risk of maternal death (MD) unless proper genetic/clinical counseling is provided and a multidisciplinary approach is adopted during pregnancy. In recent decades, there has been a significant increase in the number of women with CVD of child-bearing age and in the incidence of pregnancy among relatively older women. However, the impact of this phenomenon on MD has not been carefully investigated. Methods: This retrospective study compares the incidence and etiology of maternal deaths related to cardiovascular disease (MD-CVD) in Japan in 2010-2012 to that seen in 1991-1992. Results: Seven cases of MD-CVD were reported in 1991-1992, compared to 15 in 2010-2012. In 20102012, the causes included aortic dissection (n = 5), peripartum cardiomyopathy (n = 3), sudden adult/ arrhythmic death syndrome (n = 2), acute cardiomyopathy (n = 2), pulmonary hypertension (n = 2), and myocardial infarction (n =1), and four of these causes were not encountered in 1991-1992. The incidence of MD over the total number of pregnancies decreased from 9.4 per 100,000 cases in 19901992 to 4.6 per 100,000 cases in 2010-2012 (p < 0.05). However, the incidence of MD-CVD over the number of cases of MD increased from 2.9% in 1991-1992 to 9.7% in 2010-2012 (p < 0.05). Conclusions: The present study demonstrates that the rate of MD-CVD among the cases of MD has increased 3-fold in Japan over the past 20 years. Thus, it is of critical importance to better understand the etiologies and early signs of MD-CVD and to devise an effective management program for pregnancies complicated by CVD. (C) 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.