Cardiac medication during pregnancy, data from the ROPAC

Ruys, Titia P.E.; Maggioni, Aldo P.; Johnson, Mark R.; Sliwa, Karen; Tavazzi, Luigi; Schwerzmann, Markus; Nihoyannopoulos, Petros; Koželj, Mirta; Marelli, Ariane J.; Elkayam, Uri; Hall, Roger; Roos‐Hesselink, Jolien W.

doi:10.1016/j.ijcard.2014.09.013

Cited by 87 publications

(42 citation statements)

References 29 publications

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“…This agrees with Ruys et al who demonstrated birth weight was 280 g less when beta-blockers were used 13. A Danish study examining beta-blocker usage in women with cardiac disease (51 treated vs 124 not) found them to be associated with a significantly higher rate of SGA babies (29% vs 15%).…”

Section: Discussionsupporting

confidence: 87%

“…ROPAC reported that the babies of the 291 mothers who took beta-blockers during pregnancy had a 270 g lower mean birth weight (from 2830 g vs 3100 g) compared with the 897 babies of pregnancies where the mother did not take any medications 13. However, the authors did not correct for the cardiac lesion for which the beta-blockers were used, so it remained a possibility that the lesion itself rather than the use of beta-blockers that was responsible.…”

Section: Introductionmentioning

confidence: 99%

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Birth weight in pregnancies complicated by maternal heart disease

Cauldwell

Steer

Sterrenburg

et al. 2018

Heart

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ObjectiveTo assess median and percentile birthweight distribution in women with various groups of heart disease relative to a contemporaneous comparison group.MethodsData on birth weight and gestational age were collected from 1321 pregnancies ≥24 weeks’ gestation in 1053 women with heart disease from seven UK maternity units. Women were assigned to one of 16 groups according to their cardiac lesion. In units where it was possible, data on two births, one delivering before and one after index cases, were collected, giving 2307 comparators. Birthweight percentiles (corrected for gestational age, sex and parity) were calculated using Aberdeen norms. We assessed the association of birth weight with cardiac lesion, maternal hypoxaemia (saturations <90%), systemic ventricular function and beta-blockers.Results1321 pregnancies in women with heart disease and 2307 comparators were studied. Almost all groups with heart disease had lower median and percentile birth weights than comparators, significantly in 10 groups, the biggest effect seen in women with Fontan circulation, pulmonary hypertension, prosthetic heart valves, systemic right ventricle, Marfan syndrome, repaired tetralogy of Fallot and cardiomyopathy (in that order). In 307 pregnancies, women took beta-blockers; median birth weight adjusted for maternal age, parity and the effect of the cardiac lesion was 3116.7 g (IQR 790.4) when beta-blockers were used and 3354.3 g (IQR 634.1) when they were not (p<0.001). 17 women had saturations <90%, and median birth weight was significantly lower, 3105.4 g (IQR 1288.9) versus 3387.7 g (IQR 729.8) (p=0.006).ConclusionOur findings identify specific groups of women with heart disease at risk of having a small baby.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Birth weight in pregnancies complicated by maternal heart disease

Cauldwell

Steer

Sterrenburg

et al. 2018

Heart

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“…LBW was suggested to be related to beta-blocker use in recent literature, which we could not confirm in our population of women with pre-existent IHD,16 although the sample size for this study was too small to detect any difference. The high incidence of congenital anomalies (6%) remains unexplained; none of the mothers had congenital (heart) disease, and the incidence was unrelated to the use of known fetotoxic medication during pregnancy.…”

Section: Discussioncontrasting

confidence: 74%

Pregnancy in women with pre-existent ischaemic heart disease: a systematic review with individualised patient data

Lameijer

Burchill

Baris

et al. 2019

Heart

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IntroductionStudies on pregnancy risk in women with ischaemic heart disease (IHD) have mainly excluded pregnancies in women with pre-existent IHD. There is a need for better information about the pregnancy risks in these women and their offspring.MethodsWe performed a systematic review searching the PubMed/MEDLINE public database for pregnancy in women with pre-existent IHD analysing the cardiac, obstetric and fetal/neonatal outcome of pregnancy in women with pre-existing IHD. Individual patient data were requested from large series. The primary outcome endpoints was a composite of ischaemic complications including maternal death, acute coronary syndrome and ventricular tachycardia.Results116 women with pre-existent IHD had 124 pregnancies including one twin pregnancy. They had a 21% chance of having an uncomplicated pregnancy (completed pregnancy without cardiovascular, obstetric or fetal/neonatal complications, n=26). Primary (ischaemic) endpoints occurred in 9% (n=11). Women with atherosclerosis had more cardiovascular complications compared with pregnancies in women with other underlying pathology for IHD (50%vs23%, P=0.02) but no significant difference in occurrence of primary endpoints (13% vs 9%, P=0.53). There were two maternal cardiac deaths (2%), one of which occurred in the 18th week of pregnancy and the other postpartum. Obstetric complications occurred in 58% (n=65) of pregnancies and fetal/neonatal complications in 42% (n=47).ConclusionPregnancies in women with pre-existing IHD are high-risk pregnancies. These women have a high risk of ischaemic cardiovascular complications including 2% maternal mortality. The risk of ischaemic complications is especially high among women with atherosclerotic coronary artery disease.

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“…Preconception counselling assessment (box 3) typically includes a clinical evaluation, imaging (notably an echocardiogram), risk stratification, and a review of current medications3031 to optimise cardiac status and/or avoid fetal exposure to known teratogens, such as angiotensin converting enzyme inhibitors. Data from the European Registry on Heart Disease showed that two thirds of women took cardiac medications at some point during their pregnancy 32Table 1 and the infographic …”

Section: How Can Counselling Before Conception Help?mentioning

confidence: 99%