Pregnancy and electrocardiogram: Can a basic tool help us to understand a complex and understudied population?

In most developed countries, no major decrease in maternal mortality has been reported in recent decades and there are countries such as the United States of America where maternal morbidity and mortality have even been rising in recent years.1---3 In these cases, cardiovascular disease is the leading cause of pregnancy-related deaths and there are some well-known, identified contributing factors.2,4,5 Women are now older and begin pregnancy with more cardiometabolic risk factors and chronic conditions such as obesity, hypertension, and diabetes.Additionally, the improved management of congenital and valvular heart disease has resulted in more children with congenital heart disease surviving into adulthood, leading to more women with these conditions being able to become pregnancy.1,4 All these factors, including the significant hemodynamic changes associated with pregnancy, such as cardiac output increase and adrenergic stimuli, can pose a challenge for heart function in general but can also bring about some electrophysiological changes.1,6 Not surprisingly, maternal ventricular and atrial ectopic beats are more common in pregnancy and the likelihood of a woman having an arrhythmia is elevated during pregnancy and the postpartum period.1,6 There appears to be electrical remodeling