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Hypertensive Disorders of Pregnant Women With Heart Disease
Quick Takes
- Pre-eclampsia rates are high in women with pulmonary arterial hypertension, cardiomyopathy, and ischemic heart disease, and adverse outcomes are higher for all women with heart disease and hypertensive disorders of pregnancy (HDP), in particular for pre-eclampsia.
- Women with heart disease and pre-eclampsia had a maternal mortality rate of 3.5% and a heart failure rate of 29.1%.
- Close surveillance in a multidisciplinary context for women with HDP and heart disease is indicated, with inclusion of a neonatologist in the multidisciplinary team in preparation for the delivery.
Study Questions:
What is the prevalence of hypertensive disorders of pregnancy (HDP) and their impact on pregnancy outcome in women with various types of structural heart disease?
Methods:
The investigators assessed the prevalence and outcomes of HDP (chronic hypertension, gestational hypertension, or pre-eclampsia) in the European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Registry of Pregnancy and Cardiac Disease (ROPAC) (n = 5,739), a worldwide prospective registry of pregnancies in women with heart disease. Differences between multiple groups were assessed with one-way analysis of variance tests. Associations between baseline characteristics with pre-eclampsia (including de novo and superimposed pre-eclampsia) in women with heart disease were evaluated using univariate and multivariable logistic regression.
Results:
The overall prevalence of HDP was 10.3%, made up of chronic hypertension (5.9%), gestational hypertension (1.3%), and pre-eclampsia (3%), with significant differences between the types of underlying heart disease (p < 0.05). Pre-eclampsia rates were highest in women with pulmonary arterial hypertension (11.1%), cardiomyopathy (7.1%), and ischemic heart disease (6.3%). Maternal mortality was 1.4 and 0.6% in women with versus without HDP (p = 0.04), and even 3.5% in those with pre-eclampsia. All pre-eclampsia-related deaths were post-partum and 50% were due to heart failure. Heart failure occurred in 18.5 versus 10.6% of women with versus without HDP (p < 0.001) and in 29.1% of those with pre-eclampsia. Perinatal mortality was 3.1 versus 1.7% in women with versus without HDP (p = 0.019) and 4.7% in those with pre-eclampsia.
Conclusions:
The authors reported that adverse outcomes were increased in women with HDP, and maternal mortality was strikingly high in women with pre-eclampsia.
Perspective:
This study reports high pre-eclampsia rates in women with pulmonary arterial hypertension, cardiomyopathy, and ischemic heart disease, and adverse outcomes for all women with heart disease and HDP, in particular for pre-eclampsia. Overall, women with heart disease and HDP had higher adverse maternal and perinatal outcomes than those without HDP and very notably, women with heart disease and pre-eclampsia had a maternal mortality rate of 3.5% and a heart failure rate of 29.1%. Adverse perinatal outcomes reported in this study justify close surveillance in a multidisciplinary context for women with HDP and heart disease, with inclusion of a neonatologist in the multidisciplinary team in preparation for delivery. In the absence of a multidisciplinary heart team, long-distance digital or telephone consultations with a specialized center to optimize care are indicated.
Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Acute Heart Failure, Pulmonary Hypertension, Hypertension
Keywords: Cardiomyopathies, Heart Diseases, Heart Failure, Hypertension, Pregnancy-Induced, Maternal Mortality, Myocardial Ischemia, Patient Care Team, Perinatal Mortality, Postpartum Period, Pre-Eclampsia, Pregnancy, Pregnancy Outcome, Pulmonary Arterial Hypertension, Secondary Prevention, Vascular Diseases, Women
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