Aortic dissection in pregnancy and the postpartum period
Melissa L. Russo, Mattie Boehler-Tatman, Catherine M. Albright, Carmen C. David, L’Oreal Kennedy, Aaron W. Roberts, Sherene Shalhub, Rana O. Afifi, Melanie Case, Novelett E. Cotter, Carmen C. David, Mark Fasano, Richard Goldenberg, Jake Howitt, Timo T. Söderlund, Debra Trotter, Asaf Rabin, Mattie Boehler-Tatman, Melissa L. Russo, Laura M. Drudi, Laura L. Marks, Maisoon D. Yousif, Tabea Hoffstaetter, Ella Taubenfeld, Sreekanth Vemulapalli, Chrisanne S. Campos, Lindsey Rusche, Robert C.F. Pena, Firas F. Mussa, Gretchen MacCarrick, Earl Goldsborough, Christeen Samuel, Lillian Xu, Nicolas J. Mouawad, Eanas S. Yassa, Xiaoyi Teng, Amani D. Politano, Jesse Teindl, Lara Bloom, Rebecca Gluck, Meredith Ford O'Neal, Josephine Grima, Eileen Masciale, Takeyoshi Ota, Katelyn Wright, Alan J. Hakim, Gareth Owens, George J. Arnaoutakis, Dejah R. Judelson, Mario D’Oria, Lurdes del Rio-Sola, Mark Ajalat, Marvin Chau, Stephanie D. Talutis, Karen Woo, Max V. Wohlauer, JeniannA. Yi, Kim A. Eagle, Marion A. Hofmann Bowman, Eva Kline‐Rogers, Hyein Kim, Claudine Henoud, Scott M. Damrauer, Emilia Król, Rana O. Afifi, Alana C. Cecchi, Madeline Drake, Anthony L. Estrera, Avery M Hebert, Dianna M. Milewicz, Siddharth K. Prakash, Aaron W. Roberts, Harleen K. Sandhu, Akili Smith-Washington, Akiko Tanaka, Jacob Watson, Myra Ahmad, Catherine M. Albright, Christopher R. Burke, Peter H. Byers, L’Oreal Kennedy, Sarah Lawrence, Jenney R. Lee, Jonathan Medina, Thamanna Nishath, Julie Pham, Courtney Segal, Sherene Shalhub, Michael Soto, Linell Catalan, Megan Patterson, Nicole Ilonzo
Abstract
Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified pregnancy-associated AD as a high-priority topic, despite its rarity. The Pregnancy Working Group, which included physicians and patient stakeholders, performed a systematic literature review of pregnancy-associated AD from 1960 to 2021 and identified 6,333 articles through PubMed, OVID MEDLINE, Cochrane, Embase, CINAHL and Web of Science. The inclusion criterion was AD in pregnant populations and exclusion criteria were case reports, conference abstracts, and languages other than English. Assessment of full-text articles for eligibility after removal of duplicates from all databases yielded 68 articles to be included in the final review. Topics included were timing of AD in pregnancy, type of AD, and management considerations of pregnancy-associated AD. The Pregnancy Working Group identified gaps in knowledge and future areas of research for pregnancy-associated AD, including clinical management, mental health outcomes post AD, reproductive and genetic counseling, and contraception after AD. Future collaborative projects could be a multicenter, international registry for all pregnancy-associated AD to refine the risk factors, best practice and management of AD in pregnancy. In addition, future mixed methodology studies may be useful to explore social, mental, and emotional factors related to pregnancy-associated AD and to determine support groups' effect on anxiety and depression related to these events in the pregnancy and postpartum period.