Incidence and predictors of obstetric and fetal complications in women with structural heart disease
| Autor: | Csilla Liptai, Laura Galian, Jolien W. Roos-Hesselink, Valentina Donvito, Iris M. van Hagen, Daniel J. Murphy, Nooshin Bazargani, Marielle Morissens, Mark R. Johnson, Roger Hall, Jérôme Cornette |
|---|---|
| Přispěvatelé: | Cardiology, Obstetrics & Gynecology |
| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty Heart disease Heart Diseases Pregnancy Complications Cardiovascular Disease 030204 cardiovascular system & hematology Infant Newborn Diseases Cohort Studies 03 medical and health sciences Young Adult 0302 clinical medicine Pregnancy Risk Factors medicine Humans 030212 general & internal medicine Registries Young adult Fetal Death Fetus Obstetrics business.industry Incidence (epidemiology) Incidence valvular heart disease Infant Newborn Pregnancy Outcome medicine.disease Female Cardiology and Cardiovascular Medicine business Cohort study |
| Zdroj: | Heart, 103(20), 1610-1618. BMJ Publishing Group |
| ISSN: | 1355-6037 |
| Popis: | Objective Women with cardiac disease becoming pregnant have an increased risk of obstetric and fetal events. The aim of this study was to study the incidence of events, to validate the modified WHO (mWHO) risk classification and to search for event-specific predictors. Methods The Registry Of Pregnancy And Cardiac disease is a worldwide ongoing prospective registry that has enrolled 2742 pregnancies in women with known cardiac disease (mainly congenital and valvular disease) before pregnancy, from January 2008 up to April 2014. Results Mean age was 28.2±5.5 years, 45% were nulliparous and 33.3% came from emerging countries. Obstetric events occurred in 231 pregnancies (8.4%). Fetal events occurred in 651 pregnancies (23.7%). The mWHO classification performed poorly in predicting obstetric (c-statistic=0.601) and fetal events (c-statistic=0.561). In multivariable analysis, aortic valve disease was associated with pre-eclampsia (OR=2.6, 95%CI=1.3 to 5.5). Congenital heart disease (CHD) was associated with spontaneous preterm birth (OR=1.8, 95%CI=1.2 to 2.7). Complex CHD was associated with small-for-gestational-age neonates (OR=2.3, 95%CI=1.5 to 3.5). Multiple gestation was the strongest predictor of fetal events: fetal/neonatal death (OR=6.4, 95%CI=2.5 to 16), spontaneous preterm birth (OR=5.3, 95%CI=2.5 to 11) and small-for-gestational age (OR=5.0, 95%CI=2.5 to 9.8). Conclusion The mWHO classification is not suitable for prediction of obstetric and fetal events in women with cardiac disease. Maternal complex CHD was independently associated with fetal growth restriction and aortic valve disease with pre-eclampsia, potentially offering an insight into the pathophysiology of these pregnancy complications. The increased rates of adverse obstetric and fetal outcomes in women with pre-existing heart disease should be highlighted during counselling. |
| Databáze: | OpenAIRE |
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