Effect of Maternal Heart Disease on Fetal Growth

Gelson, Emily; Curry, Ruth; Gatzoulis, Michael Α.; Swan, Lorna; Lupton, Martin; Steer, Philip; Johnson, Mark R.

doi:10.1097/aog.0b013e31820cab69

Cited by 91 publications

(80 citation statements)

References 15 publications

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“…The most frequent perinatal complication in the heart disease group was the baby being small for gestational age. We have shown in a previous study that the offspring of women with heart disease have a lower birthweight than normal controls and this may be related to a reduced CO. 8 In this series, birthweight was not significantly different between first and second pregnancies in the heart disease group. In contrast, and consistent with previous reports, 3 mean birthweight was significantly higher in second pregnancies than in first pregnancies in the control population.…”

Section: Discussionmentioning

confidence: 72%

“…Impaired perinatal outcomes in the presence of maternal heart disease have previously been reported. 8,19 In both groups, the rate of perinatal complication was not significantly different in first and second pregnancies; however, more women with heart disease had recurrence of perinatal complications in their second pregnancy (21% versus 4%). The most frequent perinatal complication in the heart disease group was the baby being small for gestational age.…”

Section: Discussionmentioning

confidence: 95%

“…An increase in PPH has been previously reported in women with heart disease. 8,17 This may be associated with the reduced syntocinon dose we use with cardiac patients to minimise its effects on the cardiovascular system (bolus doses can cause serious hypotension) or simply increased attention to recording maternal blood loss in this high-risk group.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Only those women whose pregnancies progressed to 24 weeks' gestation were included in the study. To allow comparison with our overall population, controlling for changes in demographics and practice over time, the first woman with a first and second pregnancy who delivered her first baby on the same day as each index first pregnancy were used as controls.…”

Section: Methodsmentioning

confidence: 99%

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Maternal cardiac and obstetric performance in consecutive pregnancies in women with heart disease

Gelson

Curry

Gatzoulis

et al. 2015

BJOG

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Objective Second pregnancies are usually less complicated than first pregnancies, and have a better outcome in terms of fetal growth. We studied a group of women with heart disease to assess whether their second pregnancy was less complicated and resulted in a larger baby.Design Retrospective case control study.Setting Tertiary referral academic obstetric unit.Population First and second pregnancies in 77 women with congenital and acquired heart disease and in 154 control women were identified.Methods Data were collected from medical and obstetric records.Main outcome measures Cardiac complications, obstetric complications, intra-partum events, birthweight and perinatal complications.Results The rate of obstetric complication was greater in first pregnancies in both the heart disease and the control groups (38% versus 26%, cf. 20% versus 17%). In the heart disease group, the rate of cardiac complications was similar in first and second pregnancies (9% versus 6%). Overall, significantly more perinatal complications were seen in the heart disease group, with no significant difference between first and second pregnancies (36% versus 27%, cf. 14% versus 12%). Median birthweight was significantly higher in second pregnancies in the control group (3308 versus 3519 g P < 0.001), but not significantly different between pregnancies in the heart disease group (3014 versus 3133 g, P = 0.19).Conclusions This case control study demonstrates that women with mild to moderate heart disease have similar pregnancy outcomes in consecutive pregnancies. However, while the median birthweight was higher in the control second pregnancies, it was not increased in the women with heart disease.Keywords Birth, heart disease, obstetric outcomes, parity.Tweetable abstract A study of women with heart disease to assess whether their second pregnancy was less complicated.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Maternal cardiac and obstetric performance in consecutive pregnancies in women with heart disease

Gelson

Curry

Gatzoulis

et al. 2015

BJOG

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“…[17,25,27] Maternal cyanosis and poor cardiac output are recognized as the main risk factors for foetal growth restriction and lower birth weights. [27] The fact that, on the whole, our GUCH cohort consisted of women with good saturations and satisfactory cardiac output at baseline, and that use of medications linked with IUGR was minimal, suggests that there might be other less well-recognized factors coming into play to interfere with foetal growth in mothers with CHD. It could also be argued that the "cardiologist's definition" of good cardiac output based on imaging and functional status might not necessarily translate into equally good uteroplacental flow.…”

Section: Number Of Pregnancies (%)mentioning

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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Association of Adult Congenital Heart Disease With Pregnancy, Maternal, and Neonatal Outcomes

et al. 2019

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Key Points Question Do pregnancy, maternal, and neonatal outcomes differ in women with different types of adult congenital heart disease? Findings In this large cross-sectional study of 2114 women with adult congenital heart disease in Canada, maternal and neonatal outcomes varied by subtype of maternal heart condition. Adult congenital heart disease was associated with increased odds of adverse maternal, neonatal, and pregnancy outcomes during labor and delivery hospitalization. Meaning These findings may help to highlight the importance of understanding and considering subtypes of adult congenital heart disease in clinical management of these high-risk pregnancies.

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Effect of Maternal Heart Disease on Fetal Growth

Abstract: II.

Cited by 91 publications

References 15 publications

Maternal cardiac and obstetric performance in consecutive pregnancies in women with heart disease

Maternal cardiac and obstetric performance in consecutive pregnancies in women with heart disease

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

Association of Adult Congenital Heart Disease With Pregnancy, Maternal, and Neonatal Outcomes

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