title: The increase in the rate of maternal deaths related to cardiovascular disease in Japan from 1991-1992 to 2010-2012.
abstract: 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.
  
  
  
  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.
  
  
  
  Seven cases of MD-CVD were reported in 1991-1992, compared to 15 in 2010-2012. In 2010-2012, 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 1990-1992 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).
  
  
  
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan. Electronic address: h_tanaka@med.miyazaki-u.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.affiliation: Department of Obstetrics and Gynecology, Ise Red Cross Hospital, Mie, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Osato
authors.affiliation: Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hasegawa
authors.affiliation: Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nakata
authors.affiliation: Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Murakoshi
authors.affiliation: Division of Maternal Fetal Medicine and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshimatsu
authors.affiliation: Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sekizawa
authors.affiliation: Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Kanayama
authors.affiliation: Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan.
authors.forename: Isamu
authors.initials: I
authors.lastname: Ishiwata
authors.affiliation: Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D063130:Maternal Death / Q000209:etiology*; D008428:Maternal Mortality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000401:mortality*; D012189:Retrospective Studies
keywords: Cardiovascular disease; Maternal death; Pregnancy