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Pregnancy Outcomes in Women With Heart Disease
Study Questions:
Heart disease is the most important cause of maternal deaths in western countries. What are the contemporary diagnosis-specific outcomes in pregnant women with heart disease?
Methods:
Pregnant women with heart disease were enrolled in the ROPAC (Registry Of Pregnancy And Cardiac disease) from 2007 to 2018. Data from all pregnancies up to 1-week post-partum were included; primary outcomes were maternal mortality or heart failure; secondary outcomes were other cardiac, obstetric, or fetal complications.
Results:
A total of 5,739 pregnancies from 138 centers in 53 countries were included. Mean maternal age was 29.5 years, 45% were nulliparous, 57% had congenital heart disease, and 29% had valvular disease. Overall mortality was 0.6% (9% in the pulmonary arterial hypertension group). Heart failure occurred in 11%, arrhythmias in 2%, caesarean section delivery in 44%, obstetric complications in 17%, and fetal complications in 21%. The number of high-risk pregnancies increased over time, but complication rates fell from 2010 to 2017. Predictors for maternal complications included: prepregnancy heart failure or New York Heart Association > class II, systemic ejection fraction <40%, modified World Health Organization (mWHO) class IV, and anticoagulant use.
Conclusions:
Women with heart disease have a risk of maternal mortality and heart failure, but these rates declined from 2010 despite inclusion of more high-risk pregnancies.
Perspective:
ROPAC is the largest prospective registry of pregnant women with heart disease and includes women with various types of cardiac disease. This registry reflects diverse clinical practice in multiple countries. The results of this study show an overall risk of mortality of 0.6%; however, mortality was substantially higher in women with pulmonary arterial hypertension (9%), thus highlighting the importance of assessing specific individual factors. This study only reported mortality up to 1-week post-partum, which may substantially underestimate the risk since many cardiac complications occur in the first month post-partum. Heart failure and arrhythmias were significant complications, but these outcomes can vary in levels of severity. The predictors of adverse outcomes are consistent with prior studies.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, Acute Heart Failure, Pulmonary Hypertension, Hypertension
Keywords: Anticoagulants, Arrhythmias, Cardiac, Cesarean Section, Heart Defects, Congenital, Heart Diseases, Heart Failure, Heart Valve Diseases, Hypertension, Pulmonary, Parturition, Pregnancy, Pregnancy Outcome, Pregnancy, High-Risk, Secondary Prevention, Stroke Volume, Women
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