Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Petrus, A.H.J.; Jongert, B.L.; Kiès, P.; Sueters, M.; Jongbloed, M.R.M.; Vliegen, H.W.; Schalij, M.J.; van Lith, J.; van den Akker, T. Evaluation of mode of birth in pregnant women with heart disease. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020, 248, 150–155. [Google Scholar] [CrossRef] [PubMed]
- Ramlakhan, K.P.; Malhamé, I.; Marelli, A.; Rutz, T.; Goland, S.; Franx, A.; Sliwa, K.; Elkayam, U.; Johnson, M.R.; Hall, R.; et al. Hypertensive disorders of pregnant women with heart disease: The ESC EORP ROPAC Registry. Eur. Heart J. 2022, 43, 3749–3761. [Google Scholar] [CrossRef] [PubMed]
- Elkayam, U.; Goland, S.; Pieper, P.G.; Silversides, C.K. How to Predict Pregnancy Risk in an Individual Woman with Heart Disease. J. Am. Coll. Cardiol. 2018, 71, 2431–2433. [Google Scholar] [CrossRef]
- Regitz-Zagrosek, V.; Roos-Hesselink, J.W.; Bauersachs, J.; Blomström-Lundqvist, C.; Cífková, R.; De Bonis, M.; Iung, B.; Johnson, M.R.; Kintscher, U.; Kranke, P.; et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur. Heart J. 2018, 39, 3165–3241. [Google Scholar] [CrossRef]
- Knypinski, J.; Wolfe, D.S. Maternal Mortality Due to Cardiac Disease in Pregnancy. Clin. Obstet. Gynecol. 2020, 63, 799–807. [Google Scholar] [CrossRef]
- Ouzounian, J.G.; Elkayam, U. Physiologic changes during normal pregnancy and delivery. Cardiol. Clin. 2012, 30, 317–329. [Google Scholar] [CrossRef]
- American College of Obstetricians and Gynecologists. ACOG Clinical Document (published from January 2018 through present): Pregnancy and Heart Disease. ACOG Practice Bulletin No. 212. Obs. Gynecol. 2019, 133, 1067–1072. [Google Scholar] [CrossRef]
- Van Hagen, I.M.; Roos-Hesselink, J.W. Pregnancy in congenital heart disease: Risk prediction and counselling. Heart 2020, 106, 1853–1861. [Google Scholar] [CrossRef]
- von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gøtzsche, P.C.; Vandenbroucke, J.P.; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. J. Clin. Epidemiol. 2008, 61, 344–349. [Google Scholar] [CrossRef] [PubMed]
- Lima, F.V.; Yang, J.; Xu, J.; Stergiopoulos, K. National Trends and In-Hospital Outcomes in Pregnant Women with Heart Disease in the United States. Am. J. Cardiol. 2017, 119, 1694–1700. [Google Scholar] [CrossRef]
- Ornaghi, S.; Bellante, N.; Abbamondi, A.; Maini, M.; Cesana, F.; Trabucchi, M.; Corsi, D.; Arosio, V.; Mariani, S.; Scian, A.; et al. Cardiac and obstetric outcomes in pregnant women with heart disease: Appraisal of the 2018 mWHO classification. Open Heart 2022, 9, 001947. [Google Scholar] [CrossRef]
- Fernández-Campos, B.A.; Vargas-Peñafiel, J.; Cruz-Dominguez, M.P.; Mijangos-Chavez, J.; Mendoza-Reyes, E.; Huerta-L, I.J.; Morales-Hernández, S.; Gonzalez Tovar, N.B. Cardiac and obstetric outcomes in pregnant patients with heart disease: A retrospective cohort study. J. Matern.-Fetal Neonatal Med. 2021, 35, 5140–5148. [Google Scholar] [CrossRef]
- Hu, J.; Ye, Y.; Lu, A.; Chen, L.; Mai, Y.; Huang, G.; Wang, S. Pregnancy Outcomes in Patients with Heart Disease in China. Am. J. Cardiol. 2020, 125, 1718–1724. [Google Scholar] [CrossRef] [PubMed]
- Liu, H.; Xu, J.W.; Zhao, X.D.; Ye, T.Y.; Lin, J.H.; Lin, Q. Pregnancy outcomes in women with heart disease. Chin. Med. J. 2010, 123, 2324–2330. [Google Scholar] [CrossRef] [PubMed]
- Hink, E.; Bolte, A.C. Pregnancy outcomes in women with heart disease: Experience of a tertiary center in the Netherlands. Pregnancy Hypertens. 2015, 5, 165–170. [Google Scholar] [CrossRef] [PubMed]
- Silversides, C.K.; Grewal, J.; Mason, J.; Sermer, M.; Kiess, M.; Rychel, V.; Wald, R.M.; Colman, J.M.; Siu, S.C. Pregnancy Outcomes in Women with Heart Disease: The CARPREG II Study. J. Am. Coll. Cardiol. 2018, 71, 2419–2430. [Google Scholar] [CrossRef]
- Roos-Hesselink, J.; Baris, L.; Johnson, M.; De Backer, J.; Otto, C.; Marelli, A.; Jondeau, G.; Budts, W.; Grewal, J.; Sliwa, K.; et al. Pregnancy outcomes in women with cardiovascular disease: Evolving trends over 10 years in the ESC Registry of Pregnancy and Cardiac disease (ROPAC). Eur. Heart J. 2019, 40, 3848–3855. [Google Scholar] [CrossRef]
- Tsaitlin-Mor, L.; Nir, A.; Elchalal, U.; Bdolah-Abram, T.; Weiniger, C.F. Outcomes of pregnancy and delivery in women with cardiac disease compared to matched healthy controls. J. Matern.-Fetal Neonatal Med. 2021, 35, 5821–5827. [Google Scholar] [CrossRef]
- Owens, A.; Yang, J.; Nie, L.; Lima, F.; Avila, C.; Stergiopoulos, K. Neonatal and maternal outcomes in pregnant women with cardiac disease. J. Am. Heart Assoc. 2018, 7, e009395. [Google Scholar] [CrossRef]
- Beaton, A.; Okello, E.; Scheel, A.; Dewyer, A.; Ssembatya, R.; Baaka, O.; Namisanvu, H.; Njeri, A.; Matovu, A.; Namagembe, I.; et al. Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting. Heart 2019, 105, 755–760. [Google Scholar] [CrossRef]
- Hardee, I.; Wright, L.; McCracken, C.; Lawson, E.; Oster, M.E. Maternal and neonatal outcomes of pregnancies in women with congenital heart disease: A meta-analysis. J. Am. Heart Assoc. 2021, 10, e017834. [Google Scholar] [CrossRef] [PubMed]
- Ramage, K.; Grabowska, K.; Silversides, C.; Quan, H.; Metcalfe, A. Association of adult congenital heart disease with pregnancy, maternal, and neonatal outcomes. JAMA Netw. Open 2019, 2, e193667. [Google Scholar] [CrossRef] [PubMed]
- Lammers, A.E.; Diller, G.P.; Lober, R.; Möllers, M.; Schmidt, R.; Radke, R.M.; De-Torres-Alba, F.; Kaleschke, G.; Marschall, U.; Bauer, U.M.; et al. Maternal and neonatal complications in women with congenital heart disease: A nationwide analysis. Eur. Heart J. 2021, 42, 4252–4260. [Google Scholar] [CrossRef]
- Meng, M.L.; Arendt, K.W. Obstetric Anesthesia and Heart Disease: Practical Clinical Considerations. Anesthesiology 2021, 135, 164–183. [Google Scholar] [CrossRef]
- Hrycyk, J.; Kaemmerer, H.; Nagdyman, N.; Hamann, M.; Schneider, K.T.M.; Kuschel, B. Mode of delivery and pregnancy outcome in women with congenital heart disease. PLoS ONE 2016, 11, e0167820. [Google Scholar] [CrossRef] [PubMed]
n = 141 | |
Personal history | |
Smoking, n, % | 13 (9.2%) |
Diabetes mellitus, n, % | 3 (2.1%) |
Chronic hypertension, n, % | 5 (3.5%) |
Stroke, n, % | 2 (1.4%) |
Heart failure, n, % | 11 (7.8%) |
Cardiovascular surgeries, n, % | 36 (25.5%) |
Pre-pregnancy cardiovascular medication | 34 (24.1%) |
Known heart disease, n, % | 105 (74.5%) |
In vitro fertilization, n, % | 13 (9.2%) |
Basal cardiological characteristics | |
Pre-pregnancy consultation with cardiologist, n, % | 21 (14.8%) |
Type of heart disease, n, %: | |
Congenital heart disease | 53 (37.5%) |
Cardiomyopathy | 16 (11.3%) |
Ischemic heart disease | 2 (1.4%) |
Marfan syndrome | 2 (1.4%) |
Valve disease | 35 (24.8%) |
Rheumatic valve disease | 9 (6.3%) |
Valve prosthesis | 6 (4.3%) |
Arrhythmia | 46 (32.6%) |
Arrhythmia device | 4 (2.9%) |
Basal echocardiographic parameters, n, %: | |
Systemic ventricle ejection dysfunction (SVEF) < 55% | 13 (9.2%) |
Systemic ventricle dilatation | 13 (9.2%) |
Sub-pulmonary ventricle dysfunction | 10 (7.09%) |
Ascending aortic dilatation | 6 (4.4%) |
Systemic ventricle outflow tract obstruction | 7 (5.0%) |
Pulmonary hypertension | 2 (1.4%) |
Valvular insufficiency (moderate or severe) | 22 (15.6%) |
New York Heart Association (NYHA) functional classification, n, %: | |
I | 123 (87.2%) |
II | 18 (12.8%) |
Modified World Health Organization (mWHO) classification, n, %: | |
I | 34 (24.1%) |
II | 48 (34.0%) |
II–III | 36 (25.5%) |
III | 20 (14.2%) |
IV | 3 (2.1%) |
n = 141 | |
Use of CV medication during current pregnancy n, % | 47 (33.3%) |
Cardiovascular complications | 32/141 (22.6%) |
Deterioration of NYHA functional class, n, % | 24 (17.0%) |
MACEs (major maternal CV events), n, % | 28/141 (19.9%) |
Heart failure, n, % | 15 (10.6%) |
Peripartum cardiomyopathy, n, % | 7 (4.9%) |
Acute pulmonary oedema, n, % | 5 (3.6%) |
Thromboembolic complication, n, % | 1 (0.7%) |
Arrhythmic complication, n, % | 12 (8.6%) |
Cardiac surgery during pregnancy, n, % | 2 (1.6%) |
Hospital admission due to cardiovascular complication, n, % | 15 (10.6%) |
Maternal admission to the intensive care unit (ICU), n, % | 7 (5.0%) |
Duration of ICU admission (days) (n = 7), mean ± SD | 7.7 ± 7.1 |
Maternal Death, n, % | 0 (0%) |
n = 132 | |
Obstetric complications | 32/132 (24.2%) |
Stillbirth, n, % | 1 (0.7%) |
Threatened preterm labor, n, % | 3 (2.3%) |
Gestational hypertensive disorder, n, % | 13 (9.8%) |
Preeclampsia, n, % | 9 (6.8%) |
Fetal macrosomia n, % | 2 (1.6%) |
Oligohydramnios, n, % | 9 (7.2%) |
Intrauterine growth restriction (IUGR), n, % | 9 (7.9%) |
Hospital admission for obstetric reasons (other than delivery), n, % | 5 (3.8%) |
Postpartum hemorrhage, n, % | 4 (3.2%) |
Other obstetric variables | |
Cardiovascular cause for C-section, n, % | 7 (14.6%) |
Obstetric cause for C-section, n, % | 36 (75%) |
Both CV and obstetric cause for C-section, n, % | 5 (10.4%) |
No breastfeeding, n, % | 10 (7.6%) |
n = 136 | |
Neonatal complications | 38/136 (27.9%) |
Congenital heart disease, n, % | 18 (13.2%) |
Neonatal admission, n, % | 20 (14.7%) |
Duration of neonatal admission (days) (n = 20), mean ± SD | 6.5 ± 7.0 |
Neonatal intensive care unit admission, n, % | 4 (3.1%) |
Duration of neonatal intensive care unit admission (n = 4), mean ± SD | 5 ± 3.27 |
Total | Cases | Controls | p Value | |
---|---|---|---|---|
n = 396 | n = 132 | n = 264 | ||
Maternal Characteristics | ||||
Nulliparity, n, % | 223 (56.3%) | 73 (55.3%) | 150 (56.8%) | 0.8 2 |
Twin pregnancy, n, % | 12 (3.0%) | 4 (3.0%) | 8 (3.0%) | >0.9 2 |
Maternal age (years), mean, SD | 32.71 ± 5.84 | 33.17 ± 5.51 | 32.49 ± 5.99 | 0.3 2 |
Maternal age < 20 years | 9 (2.3%) | 2 (1.5%) | 7 (2.7%) | 0.5 2 |
Maternal age 20–35 years | 252 (63.6%) | 82 (62.1%) | 170 (64.3%) | 0.7 2 |
Maternal age 36–39 years | 98 (24.7%) | 33 (25.0%) | 65 (24.6%) | >0.9 2 |
Maternal age > 40 years | 37 (9.3%) | 15 (11.3%) | 22 (8.3%) | 0.3 2 |
Delivery results | ||||
Onset of labor, n, %: | ||||
Spontaneous | 242 (61.1%) | 60 (45.5%) | 182 (68.9%) | <0.001 2 |
Induction | 100 (25.3%) | 41 (31.1%) | 59 (22.3%) | 0.057 2 |
Type of anesthesia, n, %: | ||||
None | 26 (6.6%) | 6 (4.7%) | 20 (7.6%) | 0.3 2 |
Local | 21 (5.4%) | 3 (2.3%) | 18 (6.8%) | 0.048 2 |
Rachidial | 45 (11.4%) | 23 (17.4%) | 22 (8.3%) | 0.006 2 |
Epidural | 288 (72.7%) | 86 (65.1%) | 202 (76.5%) | 0.052 2 |
General | 12 (3.1%) | 10 (7.8%) | 2 (0.8%) | <0.001 2 |
Type of delivery, n, %: | ||||
Total C-sections | 97 (24.5%) | 49 (37.1%) | 48 (18.2%) | <0.001 2 |
Unplanned C-sections | 44 (11.1%) | 19 (14.4%) | 25 (9.5%) | 0.917 |
Scheduled C-section | 53 (13.4%) | 30 (22.7%) | 23 (8.7%) | <0.001 2 |
Total vaginal deliveries | 298 (75.3%) | 82 (62.1%) | 216 (81.8%) | <0.001 2 |
Eutocic vaginal delivery | 234 (59.1%) | 59 (44.7%) | 175 (66.3%) | <0.001 2 |
Assisted vaginal delivery | 64 (16.2%) | 23 (17.4%) | 41 (15.5%) | 0.6 2 |
Postpartum maternal admission (days), mean ± SD | 2.81 ± 2.44 | 3.49 ± 2.67 | 2.50 ± 2.26 | <0.001 2 |
Postpartum maternal admission ≥ 7 days, n, % | 15 (3.9%) | 9 (7.2%) | 6 (2.3%) | 0.025 2 |
Neonatal results | n = 408 | n = 136 | n = 272 | |
Male, n, % | 201 (49.3%) | 76 (55.9%) | 125 (46.0%) | 0.034 2 |
Gestational age (GA), mean ± SD | 38.52 ± 2.32 | 38.23 ± 2.10 | 38.66 ± 2.41 | 0.095 2 |
GA < 37 weeks | 41 (10.0%) | 18 (13.2%) | 23 (8.5%) | 0.14 2 |
GA < 34 weeks | 13 (3.2%) | 5 (3.6%) | 8 (2.9%) | 0.7 2 |
GA < 32 weeks | 7 (1.7%) | 1 (0.7%) | 6 (2.2%) | 0.2 2 |
Weight (grams), mean ± SD | 3101.87 ± 600.84 | 3012.40 ± 595.95 | 3146.77 ± 599.35 | 0.035 2 |
Weight < 2.500 g, n, % | 53 (13.0%) | 25 (18.3%) | 28 (10.3%) | 0.026 2 |
Weight percentile, n, % | 50.57 ± 31.54 | 46.62 ± 31.54 | 52.51 ± 31.42 | 0.078 2 |
Weight < 10th percentile, n, % | 48 (11.8%) | 20 (14.7%) | 28 (10.3%) | 0.2 2 |
Neonatal reanimation, n, % | ||||
None | 315 (77.2%) | 99 (72.8%) | 216 (79.4%) | 0.6 2 |
Aspiration of nasopharyngeal secretions | 14 (3.4%) | 4 (2.9%) | 10 (3.7%) | 0.8 2 |
Oxygen therapy | 15 (3.7%) | 4 (2.9%) | 11 (4.0%) | 0.6 2 |
Positive pressure ventilation | 32 (7.8%) | 13 (9.6%) | 19 (6.9%) | 0.3 2 |
Invasive ventilation | 8 (1.9%) | 2 (1.5%) | 6 (2.2%) | 0.7 2 |
Apgar test 1st minute, mean ± SD | 8.54 ± 1.27 | 8.35 ± 1.45 | 8.63 ± 1.17 | 0.043 2 |
Apgar test 1st minute < 7, n, % | 28 (6.9%) | 12 (9.0%) | 16 (5.9%) | 0.3 2 |
Apgar test 5th minute, mean ± SD | 9.51 ± 1.00 | 9.37 ± 1.20 | 9.58 ± 0.88 | 0.05 2 |
Apgar test 5th minute < 7, n, % | 4 (1.0%) | 2 (1.5%) | 2 (0.7%) | 0.5 2 |
Arterial Ph umbilical cord, mean ± SD | 7.28 ± 0.08 | 7.28 ± 0.08 | 7.28 ± 0.08 | 0.8 2 |
Arterial Ph umbilical cord < 7, n, % | 3 (0.8%) | 0 (0%) | 3 (1.1%) | 0.14 2 |
Neonatal death, n, % | 1 (0.2%) | 0 (0%) | 1 (0.4%) | 0.4 2 |
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Aracil Moreno, I.; Prieto-Arévalo, R.; Ortega-Abad, V.; Martín-Manzano, V.; Pérez-Burrel, L.; Fraile-López, A.; Devesa-Cordero, C.; Yllana-Pérez, F.; Ortega, M.A.; De León-Luis, J.A. Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study. J. Clin. Med. 2024, 13, 5084. https://doi.org/10.3390/jcm13175084
Aracil Moreno I, Prieto-Arévalo R, Ortega-Abad V, Martín-Manzano V, Pérez-Burrel L, Fraile-López A, Devesa-Cordero C, Yllana-Pérez F, Ortega MA, De León-Luis JA. Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study. Journal of Clinical Medicine. 2024; 13(17):5084. https://doi.org/10.3390/jcm13175084
Chicago/Turabian StyleAracil Moreno, Irene, Raquel Prieto-Arévalo, Virginia Ortega-Abad, Virginia Martín-Manzano, Laura Pérez-Burrel, Andrea Fraile-López, Carolina Devesa-Cordero, Fátima Yllana-Pérez, Miguel A. Ortega, and Juan A. De León-Luis. 2024. "Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study" Journal of Clinical Medicine 13, no. 17: 5084. https://doi.org/10.3390/jcm13175084
APA StyleAracil Moreno, I., Prieto-Arévalo, R., Ortega-Abad, V., Martín-Manzano, V., Pérez-Burrel, L., Fraile-López, A., Devesa-Cordero, C., Yllana-Pérez, F., Ortega, M. A., & De León-Luis, J. A. (2024). Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study. Journal of Clinical Medicine, 13(17), 5084. https://doi.org/10.3390/jcm13175084