Cardiovascular and Obstetric Delivery Complications in Pregnant Women With Valvular Heart Disease

Minhas, Anum; Rahman, Faisal; Gavin, Nicole R.; Cedars, Ari; Vaught, Arthur J.; Zakaria, Sammy; Resar, Jon R.; Schena, Stefano; Schulman, Steven P.; Zhao, Di; Hays, Allison G.; Michos, Erin D.

doi:10.1016/j.amjcard.2021.07.038

Cited by 7 publications

(3 citation statements)

References 23 publications

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“…There are data supporting that valvular heart disease is a risk factor for all forms of pre-eclampsia (preterm and term pre-eclampsia), a finding we could not confirm. 21 To our knowledge, no previous studies have investigated the association between heart failure prior to pregnancy and risk of pre-eclampsia. Heart failure is a rare diagnosis among fertile women, which makes it hard to identify an adequate number of individuals prior to pregnancy; even with our large dataset we found less than 200 women with this condition.…”

Section: Discussionmentioning

confidence: 99%

Heart disease in pregnancy and risk of pre-eclampsia: a Swedish register-based study

Bergman,

Svanvik,

Basic

et al. 2024

Open Heart

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Background and aimsPre-eclampsia complicates 3–5% of pregnancies worldwide and is associated with adverse outcomes for the mother and the offspring. Pre-eclampsia and heart failure have common risk factors, including hypertension, obesity and diabetes. It is not known whether heart failure increases the risk of pre-eclampsia. This study examines whether pregestational heart failure increases the risk of pre-eclampsia.MethodsIn a registry-based case–cohort study that included all pregnancies in Sweden (n=3 125 527) between 1990 and 2019, all pregnancies with pre-eclampsia (n=90 354) were identified and up to five control pregnancies (n=451 466) for each case were chosen, matched on the mother’s birth year. Multiple logistic regression analysis was used to evaluate the impact of heart failure on the risk of pre-eclampsia, with adjustment for established risk factors and other cardiovascular diseases.ResultsWomen with heart failure had no increased risk for pre-eclampsia, OR 1.02 (95% CI 0.69 to 1.50). Women with valvular heart disease had an increased OR of preterm pre-eclampsia, with an adjusted OR of 1.78 (95% CI 1.04 to 3.06). Hypertension and diabetes were independent risk factors for pre-eclampsia. Obesity, multifetal pregnancies, in vitro fertilisation, older age, Nordic origin and nulliparity were more common among women who developed pre-eclampsia compared with controls.ConclusionWomen with heart failure do not have an increased risk of pre-eclampsia. However, women with valvular heart disease prior to pregnancy have an increased risk of developing preterm pre-eclampsia independent of other known risk factors.

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Section: Discussionmentioning

confidence: 99%

Heart disease in pregnancy and risk of pre-eclampsia: a Swedish register-based study

Bergman,

Svanvik,

Basic

et al. 2024

Open Heart

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“… 2 A retrospective study using the National Inpatient Sample found that pregnant individuals with valvular disease had higher odds of adverse obstetrical events such as pre-eclampsia; eclampsia; intrapartum/postpartum hemorrhage; and cardiovascular events including peripartum cardiomyopathy, pulmonary edema, acute ischemic heart disease, and arrhythmias. 4 …”

Section: Question 1: What Are Maternal and Fetal Risks Related To Mec...mentioning

confidence: 99%

Preconception Counseling for a Patient With a Mechanical Tricuspid Valve

Choi,

Uribe,

Ipek

et al. 2024

JACC: Case Reports

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“…Interventions focused on women with APOs to reduce future cardiovascular risk are also an active area of investigation. Epidemiologic and population health studies using large databases—such as the National Inpatient Sample, 19 22 27 administrative claims databases, and cohort studies such as the HOPE registry, 24 —facilitate understanding. Basic science, translational research, and personalized medicine offer the opportunity to elucidate disease mechanisms and the impact of pregnancy-related CVD on long-term health.…”

Section: Core Components Of Cardio-obstetrics Trainingmentioning

confidence: 99%

Instituting a Curriculum for Cardio-Obstetrics Subspecialty Fellowship Training

Minhas

Goldstein

Vaught

et al. 2022

Methodist DeBakey Cardiovascular Journal

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Maternal mortality is rising in the United States, and cardiovascular disease is the leading cause. Adverse pregnancy outcomes such as preeclampsia and gestational diabetes heighten the risk of cardiovascular complications during pregnancy and the peripartum period and are associated with long-term cardiovascular risks. The field of cardio-obstetrics is a subspecialty within adult cardiology that focuses on the management of women with or at high risk for heart disease who are considering pregnancy or have become pregnant. There is growing recognition of the need for more specialists with dedicated expertise in cardio-obstetrics to improve the cardiovascular care of this high-risk patient population. Current recommendations for cardiovascular fellowship training programs accredited by the Accreditation Council for Graduate Medical Education involve establishing core competency in the knowledge of managing heart disease in pregnancy. However, little granular detail is available of what such training should entail, which can lead to knowledge gaps. Additionally, dedicated advanced subspecialty training in this area is not commonly offered. Multidisciplinary collaborative teams have been shown to improve outcomes in cardiac patients during pregnancy, and cardiovascular fellows-in-training interested in cardio-obstetrics should have the opportunity to participate in and contribute to a pregnancy heart team. In this document, we describe a proposed specialized cardio-obstetrics training pathway that could serve to adequately prepare trainees to competently and comprehensively care for women with cardiovascular disease before, during, and after pregnancy.

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Cardiovascular and Obstetric Delivery Complications in Pregnant Women With Valvular Heart Disease

Cited by 7 publications

References 23 publications

Heart disease in pregnancy and risk of pre-eclampsia: a Swedish register-based study

Heart disease in pregnancy and risk of pre-eclampsia: a Swedish register-based study

Preconception Counseling for a Patient With a Mechanical Tricuspid Valve

Instituting a Curriculum for Cardio-Obstetrics Subspecialty Fellowship Training

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