Outcome of Pregnancy in Patients With Structural or Ischemic Heart Disease: Results of a Registry of the European Society of Cardiology

Study Questions:

What are pregnancy outcomes among women with structural or ischemic heart disease?

Methods:

These data were collected through the European Registry on Pregnancy and Heart Disease, a registry initiated by the European Society of Cardiology in 2007. Women with a diagnosis of valvular heart disease, congenital heart disease, ischemic heart disease, or cardiomyopathy, and who were pregnant, were enrolled in this cohort. Patients from 60 hospitals in 28 countries were included from 2007 to 2011. Normal population data (derived from the literature) were used for comparison.

Results:

A total of 1,321 pregnant women were included. The median maternal age was 30 years (range 16–53 years). Congenital heart disease (66%) was most prevalent, followed by valvular heart disease (25%), cardiomyopathy (7%), and ischemic heart disease (2%). Maternal death occurred in 1%, compared with 0.007% in the normal population. The highest maternal mortality was found in patients with cardiomyopathy. A total of 338 women (26%) were hospitalized during their pregnancy, 133 for heart failure. Caesarean section was performed in 41%. Median duration of pregnancy was 38 weeks (range 24–42 weeks) and median birth weight was 3010 g (range 300–4850 g). Fetal mortality occurred in 1.7% and neonatal mortality in 0.6%, both higher than in the normal population. Maternal and fetal mortality were higher in hospitals residing in developing countries, as compared to centers residing in developed countries (3.9 vs. 0.6%, p < 0.001 and 6.5 vs. 0.9%, p < 0.001).

Conclusions:

The authors concluded that the majority of pregnant women with heart disease can complete pregnancy including delivery with a high degree of safety; however, women with cardiomyopathy had the highest mortality. Prenatal evaluation is recommended, as is improvement in care of such women in developing countries.

Perspective:

Registry data such as these are an informative means of identifying women at increased risk for adverse outcomes during pregnancy. Further research is warranted to reduce rates of such outcomes in both developing and developed countries.

Clinical Topics: Heart Failure and Cardiomyopathies, Valvular Heart Disease, Atherosclerotic Disease (CAD/PAD)

Keywords: Birth Weight, Pregnancy Outcome, Myocardial Ischemia, Coronary Artery Disease, Developing Countries, Heart Diseases, Mitral Valve Prolapse, Developed Countries, Cardiomyopathies, Cardiology, Heart Valve Diseases, Cesarean Section, Fetal Mortality, Maternal Mortality


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