Prospective Multicenter Study of Pregnancy Outcomes in Women With Heart Disease

TLDR

The maternal and neonatal risks associated with pregnancy in women with heart disease receiving comprehensive prenatal care have not been well defined. The study prospectively enrolled 562 pregnant women with heart disease and followed 599 pregnancies that did not end in miscarriage. Cardiac complications occurred in 13% of pregnancies and neonatal complications in 20%, with prior cardiac events, poor functional class or cyanosis, left heart obstruction, and left ventricular dysfunction independently predicting maternal risk, which can be estimated using a validated risk index.

Abstract

Background The maternal and neonatal risks associated with pregnancy in women with heart disease receiving comprehensive prenatal care have not been well defined. Methods and Results We prospectively enrolled 562 consecutive pregnant women with heart disease and determined the outcomes of 599 pregnancies not ending in miscarriage. Pulmonary edema, arrhythmia, stroke, or cardiac death complicated 13% of pregnancies. Prior cardiac events or arrhythmia, poor functional class or cyanosis, left heart obstruction, and left ventricular systolic dysfunction independently predicted maternal cardiac complications; the cardiac event rate can be predicted using a risk index incorporating these predictors. Neonatal complications (20% of pregnancies) were associated with poor functional class or cyanosis, left heart obstruction, anticoagulation, smoking, and multiple gestations. Conclusions Pregnancy in women with heart disease is associated with significant cardiac and neonatal complications, despite state-of-the-art obstetric and cardiac care. Maternal cardiac risk can be predicted with the use of a risk index.