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CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2023;148:e9–e119. DOI: 10.1161/CIR.0000000000001168 August 29, 2023

Virani et al 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Chronic Coronary Disease Guideline

analysis among 886 996 completed pregnancies linked to liveborn infants showed a 1.79-fold increase in risk of fetal malformations among the 1152 pregnancies with first-trimester exposure to statins, but this increase in risk was accounted for by confounders such as preexisting diabetes, lowering the relative risk to 1.07 (95% CI, 0.85-1.37) in adjusted analyses.24 A 2014 meta-analysis similarly found no increase in birth defects after statin exposure during pregnancy but found an increased risk of miscarriage that the authors attributed to underlying maternal comorbidities.25 A 2017 analysis of the UK General Practice Research Database showed a 1.64-fold increased risk of fetal loss in statin-exposed pregnancies but could not fully account for differences in baseline characteristics in exposed and unexposed pregnancies.26 The FDA concluded that data are insufficient at this time to determine whether

Figure 10. Team-Based Cardio-Obstetrics Model of Care. The cardio-obstetrics model of care involves multiple specialists working together and with the patient to address issues from preconception, through pregnancy and delivery, and the postpartum period. APO indicates adverse pregnancy outcomes; CARPREG II, Cardiac Disease in Pregnancy study; CVD, cardiovascular disease; mWHO, modified World Health Organization; ZAHARA, Zwangerschap bij Aangeboren HARtAfwijking (Pregnancy in Women With Congenital Heart Disease) study. Modified with permission from Davis MB, et al.16 Copyright 2021 American College of Cardiology Foundation.

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