Pregnancy with Heart Disease: Maternal Outcomes and Risk Factors for Fetal Growth Restriction

Abstract

Caring for children and mothers suffering from cardiac disease is highly challenging, with issues including late diagnosis as well as inadequate infrastructure and supply of drugs. We aimed to evaluate maternal outcomes among pregnant women suffering from heart disease with a live birth, and explored the risk factors for fetal growth restriction among these patients. A retrospective study was performed at the National Hospital of Obstetrics and Gynecology (Hanoi, Vietnam) over a 3-year period from 2014 to 2016. A total of 284 patients were enrolled in the study. Overall, most women were aged below 35 years and were diagnosed with heart disease before pregnancy. Of the women experiencing rheumatic heart disease, the prevalence of mitral valve regurgitation was the highest (40.14%), while the figure for aortic valve regurgitation was the lowest (4.23%). Of women with congenital heart defects, the most common defects were ventricular septal defect (VSD) and atrial septal defect (ASD) (19.37% and 16.55%, respectively), while 5.28% of mothers were diagnosed with tetralogy of Fallot and 1.76% with patent ductus arteriosus. Noted clinical presentations of the patients included palpitation (63.38%), breathlessness (23.59%), leg edema (8.45%), and chest pain (8.1%). The common complications in the study population included 16.90% of women having heart failure and 19.37% having arrhythmias. The incidence of fetal growth restriction was 9.15%. Hypertension (odds ratio (OR): 59.75, 95% confidence interval (CI): 9.1–392.17), the heart disease types (ASD (OR: 4.27, 95% CI: 1.19–15.29) and tetralogy of Fallot (OR: 6.82, 95% CI: 1.21–38.55)), and the complications (heart failure (OR: 10.34, 95% CI: 2.75–38.87) and pulmonary edema (OR: 107.16, 95% CI: 4.96–2313.93)) were observed as risk factors for intrauterine growth restriction. This study provides a cornerstone to promote further studies and to motivate people to apply evidence-based medical care for mothers with diagnosed cardiac disease in the antenatal and postnatal periods.

<p>Knowledge and Attitude of Self-Monitoring of Blood Pressure Among Adult Hypertensive Patients on Follow-Up at Selected Public Hospitals in Arsi Zone, Oromia Regional State, Ethiopia: A Cross-Sectional Study</p>

“…5 Hypertension was also observed as a risk factor for intrauterine growth restriction among pregnant women. 25 The report of meta-analysis showed the projected rate of SBP of ≥140 mm Hg and related annual deaths increased from 17,307 to 20,526 per 100 000 persons and 97.9 to 106.3 per 100 000 persons between 1990 and 2015 years globally respectively. 26 The report of systematic analysis showed about 130.2 million cases of hypertension were estimated in 2010 and a projected increase to 216.8 million cases of hypertension by 2030 in Africa.…”

Characteristics Shifting of Heart Disease in Pregnancy: A Report from Low Middle-Income Country

“…Our study showed that most cases were in reproductive ages and multigravida dominated. A study in Vietnam in 2014 -2016 showed that most pregnant women with cardiac disease were 18 -44 years 8 . Another study in Africa reported that most pregnant women with cardiac disease were < 24 years old and multigravida 23 .…”

“…It starts to emerge in developing ones as the number of cardiac diseases in low and middle-income countries increases 7 . The significant difference in pregnancy with heart disease between developed and developing countries lies in access to prenatal care 8 . While it is easier to obtain in developed countries, some developing countries still struggle in providing accessible antenatal care 9 .…”

“…Studies show that Rheumatic Heart Disease (RHD) is the most common heart disease detected during pregnancy in developing countries 8,13 . The high prevalence of infection and the delay of giving antibiotic prophylaxis for Streptococcal infections is the reason behind its high burden 8 . In contrast, congenital heart disease (CHD) is the leading cause of heart disease in pregnancy in developed countries as the advance of treatment, and perioperative care could save more babies with congenital anomalies 1,14,15 .…”

Potential Risks and Factors of Women’s Health Promotion

“…A retrospective study conducted in Vietnam from 2014 to 2016, reported an association of one of the most important maternal outcomes, intrauterine growth restriction, in pregnant women that suffer from heart diseases [ 5 ].…”