We are writing this in the week after the London 2012 Olympics. Even the most cynical of Brits were forced to join in the infectious and friendly atmosphere that impressed all visitors to a city not normally known for its welcoming and helpful inhabitants. The unifying power of sport that the world witnessed was impressive. Similarly the coming together of so many clinicians with a shared passion for the care of pregnant women with medical problems ensured that ISOM 2012 felt like a global family reunion. Thank you so much to the speakers and all those who attended and made it such a stimulating and educational meeting.
In this issue of the journal Dr Airas and Risto Kaaja review the literature on multiple sclerosis in pregnancy. Multiple sclerosis, perhaps more than any other condition, is less likely to relapse in pregnancy but the price paid is an increased rate of flare in the six months postpartum. Although disease modifying therapies such as glatiramir and interferon beta are generally thought to be safe in pregnancy, they are usually discontinued in pregnancy. This is not usually an issue because exacerbation of multiple sclerosis is unusual in pregnancy. However there is a paucity of data regarding their safety in the postpartum period when flares are more likely. The authors recommend intravenous immunoglobulin as a therapeutic option in women at high risk of relapse who wish to breast feed.
Care for women with medical problems during the puerperium and beyond often falls short compared with care during the pregnancy and yet, as David Williams highlights, the postpartum period offers the opportunity to identify and inform women about their health risks later in life if they have suffered pre-eclampsia. This is also the case for other medical problems in pregnancy, most notably gestational diabetes.
Cardiac disease remains a leading cause of maternal death in many countries. Both acquired and congenital heart disease are encountered with increasing frequency. Thorough and accurate assessment is vital to determine the presence, extent and implications of cardiac disease on pregnancy. One example is the need to perform right heart catheterization in women found to have suspected pulmonary hypertension on echocardiogram. In this issue Orchard and colleagues present a series of women requiring cardiac interventions in pregnancy and share their experience of how to reduce exposure of the fetus and uterus to ionizing radiation. These measures include the use of exchange length wires and supra diaphragmatic fluoroscopy to confirm positioning rather than traditional screening with pelvic fluoroscopy, and the use of intracardiac echocardiography rather than fluoroscopy to visualize and confirm correct deployment of the device. One does need to question however the need for PFO or ASD closure during pregnancy in 11 women. Surely not all these women had ongoing cerebral events despite adequate anticoagulation?
We encourage you all to comment on the content of the journal and respond to issues raised by other researchers and we welcome letters which we can post online. This is your journal so please do get involved.