Perspective - (2022) Volume 6, Issue 6
Received: 30-Nov-2022, Manuscript No. IPIPR-23-15430; Editor assigned: 02-Dec-2022, Pre QC No. IPIPR-23-15430 (PQ); Reviewed: 16-Dec-2022, QC No. IPIPR-23-15430; Revised: 21-Dec-2022, Manuscript No. IPIPR-23-15430 (R); Published: 28-Dec-2022, DOI: 10.21767/IPIPR.22.6.26
Treatment and prevention of the perinatal cardiovascular complications often require drug therapy. During pregnancy, the mother’s body undergoes many physiological changes. Hemodynamic changes mainly include increased circulating plasma volume, increased heart rate, decreased vascular resistance, hypercoagulability, and increased vascular wall fragility. Pregnancies with cardiovascular complications therefore have an increased incidence of heart failure, arrhythmias, thromboembolism, and aortic dissection. A registry study reported that 1/3rd of pregnant women with heart disease had taken heart medication during pregnancy, which was associated with an increased incidence of fetal adverse events. Although human experience-based assessments are more appropriate, epidemiological studies in pregnant and lactating mothers are limited, and it is difficult to include the results of such studies in the package.
Once pregnancy is established, circulating plasma volume and cardiac output increase gradually, reaching peak values from 28 weeks gestation to her 32 weeks. Pregnancy weeks are approximately 1.5 times the non-pregnancy values. The pregnant and lactating women section of the drug label is based on drug overdose studies in reproductive animals, but the applicability of animal studies to humans is limited. During labor, each contraction of the uterus transfers 200 ml-400 ml of uteroplacental blood into the systemic circulation, continuing to increase cardiac output. Immediately after childbirth, the uterus enlarges and the inferior vena cava is released, and the uterine contraction causes the blood that was circulating in the uterine artery to return to the heart, resulting in a rapid increase in venous return. It takes about 3-6 weeks or more for the volume to load normally. In response to this increased volumetric load, patients with stenotic lesions, pulmonary hypertension, and cardiac dysfunction may develop heart failure and relatively low cardiac output. Studies of perinatal heart failure have shown that in many cases of organic heart disease, heart failure develops between 20 and 30 weeks of age. Diuretics containing catecholamines, carperitide, and cardiotonics can be used to treat acute heart failure during pregnancy. The use of diuretics in chronic heart failure raises concerns about decreased uterine circulation due to excessive diuresis, oligohydramnios, dehydration due to fetal diuresis, and electrolyte imbalance. Angiotensin-Converting Enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are contraindicated because they cause fetal renal hypoplasia and oligohydramnios.
If maternal vital signs are stable and heart failure is caused by pregnancy-related fluid overload, prenatal volume depletion with diuretics or other drugs can prevent further deterioration of heart failure. Both coagulation and fibrinolysis increase during pregnancy. Mothers who are in shock with vital signs may need to give birth soon. However, systemic circulation and cardiac output continue to increase at birth. Increased risk of complications in pregnancies at high risk of thromboembolism, caution should be exercised in the use of anticoagulants and antiplatelet drugs, and adequate education and informed consent should be obtained because these drugs can affect the mother and child.
The author is grateful to the journal editor and the anonymous reviewers for their helpful comments and suggestions.
The author declared no potential conflicts of interest for the research, authorship, and/or publication of this article.
Citation: Maria R (2022) Drug Therapy for Prevention of Perinatal Cardiovascular Complications. J Pharm Pharm Res. 6:26.
Copyright: © 2022 Maria R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
