Neonatal and Maternal Outcomes in Pregnant Women With Cardiac Disease

Abstract

Background Pregnant women with underlying heart disease ( HD ) are at increased risk for adverse maternal, obstetric, and neonatal outcomes. Methods and Results Inpatient maternal delivery admissions and linked neonatal stays for women with cardiomyopathy, adult congenital HD, pulmonary hypertension ( PH ), and valvular HD were explored utilizing the Statewide Planning and Research Cooperative System (New York), January 1, 2000, through December 31, 2014, with the International Classification of Diseases, Ninth Revision , Clinical Modification (ICD‐9‐CM) . Maternal major adverse cardiac events, neonatal adverse clinical events ( NACE ), and obstetric complications were recorded. Outcomes were compared using multiple logistic regression modeling. Among 2 284 044 delivery admissions, 3871 women had HD ; 676 (17%) had cardiomyopathy, 1528 (40%) had valvular HD, 1367 (35%) had adult congenital HD, and 300 (8%) had PH . Major adverse cardiac events occurred in 16.1% of women with HD , with most in the cardiomyopathy (45.9%) and PH (25%) groups. NACE was more common in offspring of women with HD (18.4% versus 7.1%), with most in the cardiomyopathy (30.0%) and PH (25.0%) groups. Increased risk of NACE was noted for women with HD (odds ratio [ OR ]: 2.8; 95% confidence interval [ CI ], 2.5–3.0), with the highest risk for those with cardiomyopathy ( OR : 5.9; 95% CI , 5.0–7.0) and PH ( OR : 4.5; 95% CI , 3.4–5.9). Preeclampsia ( OR : 5.1; 95% CI , 3.0–8.6), major adverse cardiac events ( OR : 2.3; 95% CI , 1.8–2.9), preexisting diabetes mellitus ( OR : 4.3; 95% CI , 1.5–12.3), and obstetric complications ( OR : 2.9; 95% CI , 1.7–5.2) were independently associated with higher NACE risk. Conclusions Neonatal complications were higher in offspring of pregnant women with HD , particularly cardiomyopathy and PH . Preeclampsia, major adverse cardiac events, obstetric complications, and preexisting diabetes mellitus were independently associated with a higher risk of NACE .

Pregnancy outcomes in women with significant valve disease: a systematic review and meta-analysis

“…While fetal and neonatal complication rates were highest in severe MS, both moderate and severe MS groups had rates higher than the 0.35% stillbirth, 0.3% neonatal death, and 9% preterm birth rates found in the general population in high-income countries 28 29. When compared with fetal and neonatal complications in pregnant women with cardiomyopathy (0.4% stillbirth, 1.5% neonatal death and 25% preterm birth) the rates in severe MS are higher for fetal death but comparable for neonatal death and preterm birth 23. Improvements in maternal hemodynamics, perhaps through the use of beta-blockers in women with MS, may reduce these adverse outcomes.…”

“…Moderate and severe MS are high-risk lesions for both the mother and fetus during pregnancy. In medium/higher HDI countries, women with moderate or severe MS have a maternal mortality rates that are appreciably higher than the 0.015% rate for the general pregnancy populations of Europe and North America and the 1.9% in pregnant women with cardiomyopathy 22 23. In addition, patients with severe MS experience rates of heart failure (37%) or arrhythmias (16%) that are comparable to those in patients with cardiomyopathy (29% and 15% respectively) 23.…”

Advanced maternal age and risk of adverse perinatal outcome among women with congenital heart disease: A nationwide register‐based cohort study

“…9 Only a single study has investigated the association between maternal age, congenital heart disease, and neonatal outcomes 28 while other studies have included maternal age as a predictor of neonatal outcomes. 3,29 Furenäs et al 28 To some extent, it is questioned whether the effect of maternal age on adverse neonatal outcome is due to biology or due to selection. 30 Advanced maternal age has been associated with a range of adverse pregnancy outcomes showing the same shape of increase in risk across different outcomes 9,26,31,32 which might indicate a biologic explanation.…”

“…2 These women will in general experience more cardiac, obstetric, and neonatal complications. [2][3][4][5][6] Women in the Western world tend to delay motherhood and give birth at more advanced ages. 7,8 Advanced maternal age (≥35 years) has been associated with higher risk of foetal death, preterm birth (PTB), and giving birth to infants born small for gestational age (SGA).…”

Real-world in-hospital outcomes and potential predictors of heart failure in primigravid women with heart disease in Southwestern China

“…A prior study of > 2.2 million admissions for delivery have reported the prevalence of HD and its in-hospital outcome in the New York State during a 15-year period [17]. The differences in the composition of HD and its characteristics were detected.…”