Comparison of 3 Risk Estimation Methods for Predicting Cardiac Outcomes in Pregnant Women With Congenital Heart Disease

Lu, Chun‐Wei; Shih, Jin-Chung; Chen, Ssu-Yuan; Chiu, H. H.; Wang, Jou‐Kou; Chen, Chun-An; Chiu, Shuenn–Nan; Lin, Min; Lee, Chien‐Nan; Wu, Mei‐Hwan

doi:10.1253/circj.cj-14-1368

Cited by 58 publications

(59 citation statements)

References 31 publications

(22 reference statements)

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“…6 It is important that there are now several studies that reinforce the choice of the ESC for the modified WHO classification as the preferred model for estimation of maternal risk. 1,2,6,7, 9 A high ZAHARA score >3.51 overestimated the risk in the study of Lu et al 1 We found a similar overestimation in the high-risk groups for both CARPREG and ZAHARA. 2 This is attributable to the relative small number of patients in these groups in both CARPREG and ZAHARA studies.…”

Section: To the Editorsupporting

confidence: 76%

Towards Safer Pregnancies in Women With Congenital Heart Disease

Balcı

Roos‐Hesselink²,

Pieper

2015

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp risk of maternal mortality or severe morbidity. 5,9 This retrospective study covered the period from 1985 to 2011 and the modified WHO classification was first introduced in 2006. 5 The authors state that in the early years of their study prepregnancy counselling was not provided. Hence, it would be interesting to know whether the number of pregnant women with CHD in modified WHO class IV has declined in recent years. In our data, only 0.9% of women were in modified WHO class IV. 2 It is interesting that in the study by Lu et al the maternal complications in women with WHO class IV occurred in 25.7%, which is similar to the complication rate in women with a CARPREG score 1 and lower than the complication rate of women with a ZAHARA score >2.51, which are not regarded to constitute a contraindication to pregnancy.There is a need for studies that do not merely use a composite endpoint of complications, but that differentiate between the risk of complications such as arrhythmias, heart failure, mortality, etc. 7The study of Lu et al has great value for risk assessment of women with CHD in the Asian population and underlines the importance of external validation of existing risk models.

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Section: To the Editorsupporting

confidence: 76%

Towards Safer Pregnancies in Women With Congenital Heart Disease

Balcı

Roos‐Hesselink²,

Pieper

2015

Circ J

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“…[5][6][7][8] It is unknown whether these predictors are associated with an increased number of miscarriages/stillbirths also in patients with CHD.…”

Section: Methodsmentioning

confidence: 99%

Frequency of Miscarriage/Stillbirth and Terminations of Pregnancy Among Women With Congenital Heart Disease in Germany, Hungary and Japan

Koerten

Niwa

Szatmári

et al. 2016

Circ J

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“…[3,4,8,15] Our cardiac event rate of 3.7% is lower than what has been reported in most large studies concentrating on pregnancy in women with CHD, where cardiac event rates ranged from 4% to 25%. [1,3,5,8,13,16,17] Although this finding is reassuring, it should be interpreted with caution as it is likely to be, at least partly, due to fewer women with more complex forms of CHD and poorer baseline cardiac status in the Maltese GUCH cohort when compared to other studies referred to earlier. In fact, both CARPREG and ZAHARA risk scores for the 23/27 patients in the Maltese GUCH cohort with complete pre-pregnancy echocardiographic data were low, with an overall CARPREG mean risk of 6.91 ± 6.34% (median 5%) and an overall ZAHARA mean risk of 8.25 ± 13.89% (median 2.9%).…”

Section: Discussionmentioning

confidence: 60%

“…[3,4] Three main tools have been proposed for risk stratification of maternal cardiovascular complications among women with heart disease. [5] The CARPREG score [4] and modified World Health Organisation (WHO) classification [6,7] can be applied to women Original Article | 43…”

Section: Introductionmentioning

confidence: 99%

The Impact of Maternal Congenital Heart Disease on Pregnancy Outcomes in Malta – a Retrospective Study

Caruana

Gatt

Aquilina

et al. 2017

ICFJ

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Background: Most female patients with congenital heart disease (CHD) are becoming pregnant. Maternal CHD can have a negative impact on mother and foetus. This is the first study investigating pregnancy outcomes in Maltese grown-up congenital heart disease (GUCH) patients and one of few to compare these with outcomes in women without heart disease.Methods: Known GUCH pregnancies for the period of 2007-2014 were extracted from our database (GUCH cohort) and cardiovascular outcomes retrieved from hospital notes. A control cohort of 540 pregnancies in women without cardiovascular disease was generated through twenty-fold random matching based on subject age from among all pregnancies in Maltese nationals for the same 8-year period. Obstetric and offspring outcomes were compared between the two cohorts.Results: The GUCH cohort consisted of 27 pregnancies in 24 women. Only 1/27 patients (3.7%) had cardiovascular complications. Elective Caesarean sections were commoner (29.6% vs. 15.4%) and unassisted vaginal deliveries less frequent (51.9% vs. 64.6%) in the GUCH cohort (p=0.02). Obstetric complication rates were similar. GUCH women had smaller babies (median 3030g vs. 3230g; p=0.045) and showed a trend towards more small-for-gestational age babies (18.5% vs. 8.4%; p=0.08) and congenital malformations (7.4% vs. 2.4%; p=0.06).Conclusions: Despite the potential adverse effects of maternal CHD on mother and foetus, most pregnancies are uncomplicated and outcomes comparable to those in women without heart disease, particularly if baseline clinical status is good. Based on our findings, it is being proposed that prospective mothers be counselled about the possibility of having smaller infants.

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Comparison of 3 Risk Estimation Methods for Predicting Cardiac Outcomes in Pregnant Women With Congenital Heart Disease

Cited by 58 publications

References 31 publications

Towards Safer Pregnancies in Women With Congenital Heart Disease

Towards Safer Pregnancies in Women With Congenital Heart Disease

Frequency of Miscarriage/Stillbirth and Terminations of Pregnancy Among Women With Congenital Heart Disease in Germany, Hungary and Japan

The Impact of Maternal Congenital Heart Disease on Pregnancy Outcomes in Malta – a Retrospective Study

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