Coronary microvascular dysfunction in pregnancy: time to pay closer attention?

Overview

Coronary microvascular dysfunction (CMD) is an increasingly recognized cardiovascular condition with disproportionate prevalence among women. The pathophysiology and clinical presentation of CMD during pregnancy remain inadequately characterized. CMD may develop de novo in association with hypertensive disorders of pregnancy or manifest as worsening of pre-existing endothelial dysfunction. The clinical significance of CMD in pregnancy has not been systematically integrated into obstetric and cardiovascular management protocols.

Methods and approach

This review synthesizes current evidence on CMD in pregnancy through examination of existing diagnostic methodologies, treatment paradigms, and identified research gaps. The analysis encompasses the epidemiologic patterns of CMD in pregnant populations, potential mechanisms of disease genesis or progression during gestation, and limitations of available diagnostic modalities. The review identifies critical deficiencies in clinical knowledge that impede effective management and patient stratification.

Key Findings

Current diagnostic approaches to CMD in pregnancy are constrained by technical limitations and lack of pregnancy-specific validation. Management strategies remain largely extrapolated from non-pregnant populations and are not optimized for the physiologic alterations inherent to pregnancy. The relationship between CMD and hypertensive disorders of pregnancy requires further mechanistic elucidation. Substantial gaps exist regarding the long-term cardiovascular sequelae of CMD diagnosed or developing during gestation.

Implications

Recognition of CMD as a significant cardiovascular concern in pregnant women necessitates development of pregnancy-adapted diagnostic protocols and risk stratification frameworks. Integration of CMD assessment into routine evaluation of women with pregnancy-related cardiovascular complications may identify high-risk subpopulations requiring targeted intervention. Future investigation must clarify the temporal relationship between CMD development and pregnancy-associated complications, including the potential for persistent dysfunction postpartum.