Impact of Heart Disease During Pregnancy on Maternal Cardiac and Obstetric Outcomes [33L]

Abstract

INTRODUCTION: Heart Disease (HD) is the leading cause of morbidity and mortality among pregnant women in developed countries. The impact of HD and obstetric complications on outcome requires investigation. METHODS: Statewide Planning and Research Cooperative System database from New York State was used to characterize inpatient singleton deliveries, 2000-2014. Primary outcome was maternal Major Adverse Cardiac Events (MACE), a composite of death, cardiac arrest, myocardial infarction, heart failure, and arrhythmia. Obstetric complications included antepartum and postpartum hemorrhage, eclampsia/preeclampsia, placental insufficiency, and preterm delivery (less than 37 weeks gestation). ANOVA and Pearson's Chi-squared test were used for comparison. RESULTS: We studied 3,871 women with HD and 2,280,173 without HD, with singleton births. 17% had cardiomyopathy (CDM), 40% valvular HD, 35% congenital HD, and 8% pulmonary hypertension (PH). Compared with women without, women with HD had significantly more MACE (16.1 vs 0.4%), more cesarean delivery (45.1 vs 31.0 %), more eclampsia/preeclampsia (11.0 vs 4.2%), more preterm delivery (14.2 vs 5.5%), longer length of stay (4.8±7.3 vs 2.9±2.2 days) and higher total hospital charges ($21,384±47,037 vs 10,175±9,698, all P < .0001). Among women with HD, highest MACE rates were observed in women with CDM and PH (45.9 and 25.0% respectively), and lowest in women with congenital HD (6.1%). Women with CDM and PH also had highest rate of eclampsia/preeclampsia (25.3 and 23.3%, respectively). CONCLUSION: Pregnant women with CDM and PH had the highest rates of MACE during hospitalization for delivery. Eclampsia/preeclampsia was significantly more common in pregnant women with HD, particularly in women with CDM and PH.