Clinical features and peripartum outcomes in pregnant women with cardiac disease: a nationwide retrospective cohort study in Japan

Abstract

Although the number of pregnancies in women with cardiac disease is increasing worldwide, there are few data concerning their clinical characteristics and peripartum outcomes. Using the Diagnosis Procedure Combination database between 2008 and 2014 in Japan, we retrospectively identified pregnant women who underwent high-risk delivery due to obstetric or non-obstetric comorbidities. We classified eligible women into those with pre-existing cardiac disease (cardiac disease group) and those with non-cardiac comorbidities (non-cardiac disease group) and compared their characteristics and peripartum outcomes. Of 94,364 women undergoing high-risk delivery at 556 hospitals, 857 (0.91%) had pre-existing cardiac disease (302, congenital heart disease; 190, arrhythmia; 176, valvular heart disease; 120, ischemic heart disease; 65, cardiomyopathy; 4, pericardial disease). Women in the cardiac disease group were more likely to be treated at university hospitals (51.1 versus 28.6%; p < 0.001) and in intensive care units (33.5 versus 18.8%; p < 0.001) than those in the non-cardiac disease group. The proportion of cesarean deliveries was 69.4% (emergency, 28.4%; elective, 41.1%) in the cardiac disease group and 73.4% (emergency, 38.4%; elective, 35.0%) in the non-cardiac disease group. Epidural analgesia during vaginal delivery was used significantly more frequently in the cardiac disease than non-cardiac disease group (15.6 versus 2.3%; p < 0.001). Heart failure occurred more frequently in the cardiac disease than the non-cardiac disease group (10.2 versus 0.3%; p < 0.001). In cardiac subgroup comparisons, heart failure occurred more frequently in women with congenital heart disease (12.3%), valvular heart disease (12.5%), or cardiomyopathy (12.3%) than in women with arrhythmia (6.3%) or ischemic heart disease (5.8%). Multivariable logistic regression analysis showed a significant positive association between pre-existing cardiac disease and risk of heart failure (adjusted odds ratio, 24.7; 95% confidence interval, 17.6-34.6; p < 0.001). No woman in the cardiac disease group died, whereas 18 women (0.02%) in the non-cardiac disease group did (p = 1.000). These findings suggest that pregnant women with pre-existing cardiac disease are at a higher risk of heart failure during the peripartum period than those with non-cardiac comorbidities.

Outcomes of women with congenital heart disease admitted to acute-care hospitals for delivery in Japan: a retrospective cohort study using nationwide Japanese diagnosis procedure combination database

“…During the study period, no deaths associated with childbirth were observed. This was consistent with previous reports from Japan [13][14][15]. On the other hand, the incidence of peripartum cardiovascular events, most of which were heart failure, arrhythmias, and thromboembolic events, were discordant between the studies [5,[13][14][15].…”

“…This was consistent with previous reports from Japan [13][14][15]. On the other hand, the incidence of peripartum cardiovascular events, most of which were heart failure, arrhythmias, and thromboembolic events, were discordant between the studies [5,[13][14][15]. The discordance may potentially be attributed to the definition or severity of adverse events.…”

“…Although, the DPC database included a larger number of childbirths than previous Japanese cohort studies [11][12][13][14][15], which enabled us to evaluate the current nationwide status, our study had several limitations. First, some data could not be identified from the DPC database.…”

“…A previous retrospective cohort study using DPC database compared clinical features and peripartum outcomes between pregnant women with cardiac diseases and those without cardiac diseases, in which, 302 deliveries by women with CHD were identified for 6 years [13]. However, the identification of CHD was not exhaustive, therefore, types and numbers of CHD included were relatively small.…”

“…The Japanese guidelines estimated that childbirth by women with cardiac diseases accounts for 0.5-1.0% of the total pregnancies in Japan [9]. Nonetheless, the data are scant due to the relatively small number of patients and institutes included as well as the exclusion of critically ill patients [11][12][13][14][15]. Additionally, the definitions and severities of peripartum cardiovascular events have been inconsistent among studies [5,14,15].…”