Download PDF
Z Geburtshilfe Neonatol 2024; 228(06): 507-513
DOI: 10.1055/a-2311-4945
Original Article

Maternal Cardiac Disease and Perinatal Outcomes in a Single Tertiary Care Center

Huriye Ezveci 
1   Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
,
Şükran Doğru 
1   Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
,
Fatih Akkuş
1   Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
,
Ülfet Sena Metin
2   Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology, Konya, Turkey
,
Kazim Gezginc
1   Necmettin Erbakan University (NEU) Meram Faculty of Medicine, Clinic of obstetric and gynecology Division of maternal and fetal medicine, Konya, Turkey
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective This study aims to compare the perinatal outcomes of pregnant women with heart disease and a healthy pregnant control group, as well as the maternal and newborn outcomes of pregnant women with congenital heart disease and acquired heart disease.

Material method Pregnant women with heart disease and healthy control pregnant women were included in this retrospective study. Sociodemographic data of all patients included in the study were obtained from electronic records. Perinatal outcomes of all patients were compared.

Results A total of 258 pregnant women were included in the study. While 129 pregnant women were diagnosed with heart disease, 129 patients were low-risk pregnant women. Preeclampsia (p=0.004) and cesarean section (p=0.01) rates were higher in pregnant women with heart disease compared to healthy pregnant women. Compared with healthy pregnant women, pregnant women with heart disease had a lower birth weight (p=0.003), a higher fetal growth restriction (FGR) rate (p=0.036), lower birth percentiles (p=0.002), a lower 5-minute APGAR (p=0.0001), a higher neonatal intensive care unit (NICU) admission rate (p=0.001), and a longer NICU stay rate (p=0.001). The mean gestational age at birth of pregnant women with congenital heart disease was higher than that of those with acquired heart disease (p=0.017).

Conclusion It was observed that all maternal heart diseases were associated with adverse perinatal outcomes compared to healthy pregnant women. In this series, perinatal adverse outcomes of pregnant women with congenital and acquired heart disease did not differ. Keywords: acquired heart disease, congenital heart disease, pregnancy

Keywords

acquired heart disease - congenital heart disease - pregnancy


Publication History

Received: 07 December 2023

Accepted: 11 April 2024

Article published online:
03 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Campbell DA. An Update on the United Nations Millennium Development Goals. J Obstet Gynecol Neonatal Nurs 2017; 46: e48-e55
    CrossrefPubMedSearch in Google Scholar
  • 2 Owens A, Yang J, Nie L. et al. Neonatal and maternal outcomes in pregnant women with cardiac disease. J Am Heart Assoc 2018; 7: e009395
    CrossrefPubMedSearch in Google Scholar
  • 3 Hidano G, Uezono S, Terui K. A retrospective survey of adverse maternal and neonatal outcomes for parturients with congenital heart disease. Int J Obstet Anesth 2011; 20: 229-235
    CrossrefPubMedSearch in Google Scholar
  • 4 Goya M, Casellas M, Merced C. et al. Predictors of obstetric complications in women with heart disease. J Matern Fetal Neonatal Med 2016; 29: 2306-2311
    CrossrefPubMedSearch in Google Scholar
  • 5 Ramlakhan KP, Johnson MR, Roos-Hesselink JW. Pregnancy and cardiovascular disease. Nat Rev Cardiol 2020; 17: 718-731
    CrossrefPubMedSearch in Google Scholar
  • 6 Roos-Hesselink J, Baris L, Johnson M. 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
    CrossrefPubMedSearch in Google Scholar
  • 7 Lima FV, Yang J, Xu J. et al. national trends and in-hospital outcomes in pregnant women with heart disease in the United States. Am J Cardiol 2017; 119: 1694-1700
    CrossrefPubMedSearch in Google Scholar
  • 8 Tsaitlin-Mor L, Nir A, Elchalal U. et al. Outcomes of pregnancy and delivery in women with cardiac disease compared to matched healthy controls. J Matern Fetal Neonatal Med 2022; 35: 5821-5827
    CrossrefPubMedSearch in Google Scholar
  • 9 Goldstein SA, Ward CC. Congenital and acquired valvular heart disease in pregnancy. Curr Cardiol Rep 2017; 19: 96
    CrossrefPubMedSearch in Google Scholar
  • 10 Baghel J, Keepanasseril A, Pillai AA. et al. Prediction of adverse cardiac events in pregnant women with valvular rheumatic heart disease. Heart 2020; 106: 1400-1406
    CrossrefPubMedSearch in Google Scholar
  • 11 Hameed A, Karaalp IS, Tummala PP. et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol 2001; 37: 893-899
    CrossrefPubMedSearch in Google Scholar
  • 12 Gonzalez JM, Harris I, Jimenez Ramirez N. et al. Maternal cardiac disease and perinatal outcomes in a single tertiary care center. J Matern Fetal Neonatal Med 2023; 36: 2223336
    CrossrefPubMedSearch in Google Scholar
  • 13 Silversides CK, Grewal J, Mason J. et al. Pregnancy outcomes in women with heart disease: The CARPREG II Study. J Am Coll Cardiol 2018; 71: 2419-2430
    CrossrefPubMedSearch in Google Scholar
  • 14 Drenthen W, Boersma E, Balci A. et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 2010; 31: 2124-2132
    CrossrefPubMedSearch in Google Scholar
  • 15 Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J. et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39: 3165-3241
    CrossrefPubMedSearch in Google Scholar
  • 16 Kim YY, Goldberg LA, Awh K. et al. Accuracy of risk prediction scores in pregnant women with congenital heart disease. Congenit Heart Dis 2019; 14: 470-478
    CrossrefPubMedSearch in Google Scholar
  • 17 Balci A, Sollie-Szarynska KM, van der Bijl AG. et al. Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease. Heart 2014; 100: 1373-1381
    CrossrefPubMedSearch in Google Scholar
  • 18 Lu CW, Shih JC, Chen SY. et al. Comparison of 3 risk estimation methods for predicting cardiac outcomes in pregnant women with congenital heart disease. Circ J 2015; 79: 1609-1617
    CrossrefPubMedSearch in Google Scholar
  • 19 Pijuan-Domènech A, Galian L, Goya M. et al. Cardiac complications during pregnancy are better predicted with the modified WHO risk score. Int J Cardiol 2015; 195: 149-154
    CrossrefPubMedSearch in Google Scholar
  • 20 ACOG Practice Bulletin No. 212 Pregnancy and Heart Disease. Obstet Gynecol 2019; 133: e320-e356
    CrossrefPubMedSearch in Google Scholar
  • 21 Vause S, Clarke B. Heart disease in pregnancy. Br J Hosp Med (Lond) 2012; 73: 319-323
    CrossrefPubMedSearch in Google Scholar
  • 22 Gabriel Altit M, Leduc L, Dallaire F. Pregnancies with maternal heart disease: small babies, big problems?. Can J Cardiol 2021; 37: 1908-1909
    CrossrefPubMedSearch in Google Scholar
  • 23 Roos-Hesselink JW, Ruys TP, Stein JI. et al. Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. Eur Heart J 2013; 34: 657-665
    CrossrefPubMedSearch in Google Scholar
  • 24 Silversides CK, Grewal J, Mason J. et al. Pregnancy outcomes in women with heart disease: the CARPREG II study. J Am Coll Cardiol 2018; 71: 2419-2430
    CrossrefPubMedSearch in Google Scholar
  • 25 Siu SC, Sermer M, Colman JM. et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 2001; 104: 515-521
    CrossrefPubMedSearch in Google Scholar
  • 26 Bhatla N, Lal S, Behera G. et al. Cardiac disease in pregnancy. Int J Gynaecol Obstet 2003; 82: 153-159
    CrossrefPubMedSearch in Google Scholar
  • 27 Ueland K, Novy MJ, Metcalfe J. Hemodynamic responses of patients with heart disease to pregnancy and exercise. Am J Obstet Gynecol 1972; 113: 47-59
    CrossrefPubMedSearch in Google Scholar
  • 28 Hameed AB, Lawton ES, McCain CL. et al. Pregnancy-related cardiovascular deaths in California: beyond peripartum cardiomyopathy. Am J Obstet Gynecol 2015; 213: 379.e371-379.e310
    CrossrefPubMedSearch in Google Scholar
  • 29 Opotowsky AR, Siddiqi OK, Webb GD. Trends in hospitalizations for adults with congenital heart disease in the US. J Am Coll Cardiol 2009; 54: 460-467
    CrossrefPubMedSearch in Google Scholar
  • 30 Koutrolou-Sotiropoulou P, Parikh PB, Miller C. et al. Impact of heart disease on maternal and fetal outcomes in pregnant women. Am J Cardiol 2015; 116: 474-480
    CrossrefPubMedSearch in Google Scholar
  • 31 Wald RM, Silversides CK, Kingdom J. et al. Maternal cardiac output and fetal doppler predict adverse neonatal outcomes in pregnant women with heart disease. J Am Heart Assoc 2015; 4: e002414
    CrossrefPubMedSearch in Google Scholar
  • 32 Lima FV, Koutrolou-Sotiropoulou P, Parikh PB. et al. Pregnant women with heart disease: placental characteristics and their association with fetal adverse events. Acute Card Care 2016; 18: 56-64
    CrossrefPubMedSearch in Google Scholar
  • 33 Moons P, Bovijn L, Budts W. et al. Temporal trends in survival to adulthood among patients born with congenital heart disease from 1970 to 1992 in Belgium. Circulation 2010; 122: 2264-2272
    CrossrefPubMedSearch in Google Scholar
  • 34 Siu SC, Colman JM. Heart disease and pregnancy. Heart 2001; 85: 710-715
    CrossrefPubMedSearch in Google Scholar
  • 35 Lind J, Wallenburg HC. The Marfan syndrome and pregnancy: a retrospective study in a Dutch population. Eur J Obstet Gynecol Reprod Biol 2001; 98: 28-35
    CrossrefPubMedSearch in Google Scholar
  • 36 Monnery L, Nanson J, Charlton G. Primary pulmonary hypertension in pregnancy; a role for novel vasodilators. Br J Anaesth 2001; 87: 295-298
    CrossrefPubMedSearch in Google Scholar
  • 37 Yentis S, Steer P, Plaat F. Eisenmenger's syndrome in pregnancy: maternal and fetal mortality in the 1990s. Br J Obstet Gynaecol 1998; 105: 921-922
    CrossrefPubMedSearch in Google Scholar
  • 38 Oberhänsli I, Extermann P, Jaggi E. et al. Fetal echocardiography in pregnancies of women with congenital heart disease-clinical utility and limitations. Thorac Cardiovasc Surg 2000; 48: 323-327
    Thieme ConnectPubMedSearch in Google Scholar
  • 39 Gei AF, Hankins GD. Cardiac disease and pregnancy. Obstet Gynecol Clin North Am 2001; 28: 465-512
    CrossrefPubMedSearch in Google Scholar
  • 40 Owens A, Yang J, Nie L. et al. Neonatal and maternal outcomes in pregnant women with cardiac disease. J Am Heart Assoc 2018; 7: e009395
    CrossrefPubMedSearch in Google Scholar
  • 41 Greutmann M, Pieper PG. Pregnancy in women with congenital heart disease. Eur Heart J 2015; 36: 2491-2499
    CrossrefPubMedSearch in Google Scholar
  • 42 Drenthen W, Pieper PG, Roos-Hesselink JW. et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007; 49: 2303-2311
    CrossrefPubMedSearch in Google Scholar
  • 43 Drenthen W, Boersma E, Balci A. et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J 2010; 31: 2124-2132
    CrossrefPubMedSearch in Google Scholar