Little is known about pregnancies among cardiology fellows in training (FITs). While radiation badges are available to monitor exposure during pregnancy, among surveyed cardiology FITs in 2010, only 60% used radiation badges to monitor exposure, and 23% knew their radiation exposure.^1,2 To better understand the contemporary experience of pregnancy during cardiology training, we administered a voluntary survey.

Cardiology FITs or practicing cardiologists who had been pregnant during cardiology training were eligible. The survey (developed from author review of prior literature and subject matter experience) contained 13 questions with an opportunity for free text comments and was distributed via (1) the Women in Cardiology booth during the 2023 American College of Cardiology (ACC) Conference; (2) the Women in Electrophysiology Luncheon at the 2023 Heart Rhythm Society (HRS) Conference; and (3) the HRS Women in Electrophysiology listserv (n鈥�=鈥�135). No compensation was received. Surveys were collected from March 4, 2023, to July 4, 2023. Per the Common Rule (45 CFR 搂46), the survey received a waiver from the University of California, San Francisco Review Board and followed the reporting guideline.

A total of 57 surveys were completed (15 at ACC, 15 at HRS, and 27 through listserv) comprising 60 pregnancies. Respondents were more likely to be pregnant during or after 2020 (51% [29]) at an academic institution (93% [53]) during subspecialty fellowship (52% [31]). There were no complications for 67% of pregnancies (40), while 15% (9) experienced miscarriage, 8% (5) low birth weight, 3% (2) preterm delivery, and 7% (4) other complications including preeclampsia, eclampsia, and emergent cesarean delivery. While most respondents reported access to well-fitted lead, radiation shields, and dosimeters, as well as comfort disclosing pregnancy (Figure), they had neither reliable dosimetry data access nor female colleagues to provide advice.

This survey study of women who were pregnant during cardiology fellowship identified that health and safety measures were variably enforced during pregnancy. Suboptimal enforcement of basic radiation safety standards highlights the relevance of these findings to all cardiologists, irrespective of gender or ability to become pregnant.

We offer several strategies to improve the pregnancy experience of cardiology FITs based on our results (Figure). Educational resources for pregnant FITs exist and should be disseminated at the start of training. These include speaking with a radiation safety officer about institution-specific protocols and informational tools published by the Society for Cardiovascular Angiography and Interventions and Women as One.^2,3 New technologies have demonstrated enhanced radiation protection over standard lead, yet their efficacy in pregnancy remains unstudied.⁴ As radiation technologies continue to develop, evaluating their impact in fetal radiation exposure should specifically be considered. Knowing that a safe, well-monitored pregnancy is possible during cardiology training is not only crucial for current FITs but may encourage earlier pregnancy declarations and boost the future recruitment of women into procedural subspecialties.⁵

Our observed rate of obstetrical complications (33%) was similar to the rate reported in a 2013 study of 238 medical and surgical residents in North America (34%).⁶ 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. 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.

This survey underlines the importance of evaluating and mitigating adverse effects of medical training among pregnant women performing procedures. As the impact of radiation and obstetrical complications is cumulative over a woman鈥檚 career, the need to adopt safe standards of practice early during training is imperative. We call on all fellowship programs to develop standardized comprehensive approaches for enhancing programs for a goal of pregnancy safety during training.

Accepted for Publication: May 28, 2024.

Published Online: August 7, 2024. doi:10.1001/jamacardio.2024.2294

Correction: This article was corrected on September 11, 2024, to fix percentage values in the Results and Discussion.

Corresponding Author: Leila Haghighat, MD, MPhil, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (leila.haghighat@ucsf.edu).

Author Contributions: Dr Haghighat had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Haghighat, Pellegrini.

Drafting of the manuscript: Haghighat.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Haghighat.

Administrative, technical, or material support: Kalantarian, Pellegrini.

Supervision: Kalantarian, DesJardin, Pellegrini.

Conflict of Interest Disclosures: Dr Pellegrini reported receiving personal consultation fees from Abbott, Biosense Webster, and Cook Medical outside the submitted work. No other disclosures were reported.

Data Sharing Statement: See the Supplement.

Additional Contributions: The authors would like to acknowledge the ACC Women in Cardiology Council and the following colleagues for their invaluable support in this study: Atif Qasim MD, who helped with study design, and Rita Redberg, MD MSc, and Gina Lundberg, MD, who helped with survey dissemination. No compensation was received.