Pregnant Cardiology Trainees Report High Complication Rates, Lack of Radiation Safety

Trainees in cardiovascular medicine who become pregnant experience a rate of complications, including miscarriage, that’s higher than what is seen in the general population but on par with residents in different medical fields, according to new survey data. Additionally, researchers found, radiation safety practices that might be protective during pregnancy seem to be inconsistent.

“Especially as more and more women are going into cardiology, I think we're realizing it's a bigger issue,” lead author Leila Haghighat, MD (University of California, San Francisco), told TCTMD. On the other hand, she said, it’s challenging to study, as the population of cardiologists in training is already small and even fewer of them are pregnant.

This is not the first time pregnancy outcomes have been scrutinized for early-career physicians—cardiothoracic surgeons recently published survey data with the goal of improving the treatment of pregnant residents and prior US data have shed light on how pregnancy can impact cardiologists. Radiation exposure in cardiology is of unique concern given the limited knowledge of how it might affect a growing fetus.

Stéphane Manzo-Silberman, MD (Sorbonne Université, Paris, France), who previously co-authored a statement on pregnancy in the cath lab from the European Association of Percutaneous Cardiovascular Interventions, told TCTMD that although this study is small, it provides additional information to begin to improve outcomes.

What is consistent, and challenging, across the field is that “that these trainees are young women exposed to a high workload” as well as a competitive environment, she said.

Survey Findings

For the study, published online this week as a research letter in JAMA Cardiology, Haghighat and colleagues surveyed 57 current fellows and early-career physicians who had been pregnant a total of 60 times during their cardiology training. All surveys were conducted in person at three large cardiology conferences between March and July 2023.

Forty percent of respondents reported some sort of pregnancy complication, including 15% miscarriage, 8% low birth weight, 3% preterm delivery, and 7% others (ie, preeclampsia, eclampsia, and emergent cesarean delivery). The complication rate was similar to what was reported in a 2013 survey of medical and surgical residents.

“Notably, this study reported an incidence of miscarriage (11.8%) and low birth weight (9.2%) that was similar to our observed rates and significantly higher than an age-matched control group without medical training,” Haghighat and colleagues write. “Taken together, these results suggest medical training itself is possibly associated with excess obstetrical risk independent of radiation exposure. Study limitations include small sample size and selection bias. Those with particularly adverse experiences may have been more inclined to participate.”

Most respondents said they had access to well-fitted lead aprons, radiation shields, and dosimeters, and a majority said they had been comfortable disclosing their pregnancy. However, many reported having no access to reliable dosimetry data nor to advice from female colleagues.

Solutions for ‘Vulnerable’ Trainees

The researchers suggest several solutions, including monthly reports of individual and fetal radiation exposure as well as anonymous fetal dosimeters, ACGME standardization and oversight of radiation safety best practices, adoption of new radiation technology (with evaluation in pregnancy), and better trainee education from radiation safety officers as well as national societies.

Haghighat said more practical conversations are one example of how progress could be made. “When you're in a procedure with fluoroscopy: how can you optimize your positioning of yourself, the positioning of the patient, and the equipment to try and minimize your radiation exposure?” she explained. “I think those actual tips and tricks often we don't talk about in training curriculum.

“It's important to actually have an explicit discussion about that with fellows, not assume that they're going to pick it up, or learn it on their own,” Haghihat emphasized.

The call for standardization is especially important given how “vulnerable” pregnant trainees can be, she added. “There's a hierarchy in medicine, and I think when you're a trainee, there may be a tendency to not speak up about or feel like you can't rise up the ladder and ask for things.” Standardized systems mean trainees don’t have to “leave their comfort zone to advocate for themselves for what should be very routine safety standards and measures,” Haghighat said.

Broader Issues

In an accompanying editorial, Ann Marie Navar, MD, PhD (University of Texas Southwestern Medical Center, Dallas), and colleagues write that the study identifies “one tangible priority area for improvement in cardiology training.” It’s a multifaceted issue in itself, because while pregnant trainees deserve protection, they also need privacy, the editorialists write. Also, so much remains unknown regarding the effects of radiation exposure on a fetus, ovaries, as well as reproductive health in general.

But overall, pregnant trainees face even broader issues, such as limited parental leave and insurance coverage for fertility preservation, they say. “As a professional community focused on improving the health and outcomes of our patients, we must extend the same mission to the next generation of trainees. It is our obligation to prioritize, support, and ensure the health of our trainees as a holistic component of our approach alongside competencies and proficiencies in medicine.”

Manzo-Silberman emphasized that these are not issues that solely affect female trainees. “Men have to be also involved, and more and more young male cardiologists are taking paternity leaves and asking for better work life balance also,” she said.