title: Heart valve prostheses in pregnancy: outcomes for women and their infants.
abstract: BACKGROUND
  As the prognosis of women with prosthetic heart valves improves, an increasing number are contemplating and undertaking pregnancy. Accurate knowledge of perinatal outcomes is essential, assisting counseling and guiding care. The aims of this study were to assess outcomes in a contemporary population of women with heart valve prostheses undertaking pregnancy and to compare outcomes for women with mechanical and bioprosthetic prostheses.
  
  
  RESULTS
  Longitudinally linked population health data sets containing birth and hospital admissions data were obtained for all women giving birth in New South Wales, Australia, 2000-2011. This included information identifying presence of maternal prosthetic heart valve. Cardiovascular and birth outcomes were evaluated. Among 1 144 156 pregnancies, 136 involved women with a heart valve prosthesis (1 per 10 000). No maternal mortality was seen among these women, although the relative risk for an adverse event was higher than the general population, including severe maternal morbidity (139 versus 14 per 1000 births, rate ratio [RR]=9.96, 95% CI 6.32 to 15.7), major maternal cardiovascular event (44 versus 1 per 1000, RR 34.6, 95% CI 14.6 to 81.6), preterm birth (183 versus 66 per 1000, RR=2.77, 95% CI 1.88 to 4.07), and small-for-gestational-age infants (193 versus 95 per 1000, RR=2.03, 95% CI 1.40 to 2.96). There was a trend toward increased maternal and perinatal morbidity in women with a mechanical valve compared with those with a bioprosthetic valve.
  
  
  CONCLUSIONS
  Pregnancies in women with a prosthetic heart valve demonstrate an increased risk of an adverse outcome, for both mothers and infants, compared with pregnancies in the absence of heart valve prostheses. In this contemporary population, the risk was lower than previously reported.
authors: Clinical Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, Australia (C.M.L., C.S.A., J.B.F., C.L.R.) Department of Cardiology, Royal North Shore Hospital, St Leonards, Australia (C.M.L., G.A.F.).
authors: Claire M
authors: CM
authors: Lawley
authors: Clinical Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, Australia (C.M.L., C.S.A., J.B.F., C.L.R.).
authors: Charles S
authors: CS
authors: Algert
authors: Clinical Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, Australia (C.M.L., C.S.A., J.B.F., C.L.R.).
authors: Jane B
authors: JB
authors: Ford
authors: Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, Australia (T.A.N.).
authors: Tanya A
authors: TA
authors: Nippita
authors: Department of Cardiology, Royal North Shore Hospital, St Leonards, Australia (C.M.L., G.A.F.).
authors: Gemma A
authors: GA
authors: Figtree
authors: Clinical Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, Australia (C.M.L., C.S.A., J.B.F., C.L.R.).
authors: Christine L
authors: CL
authors: Roberts
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D001705:Bioprosthesis / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D009517:New South Wales / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology* / Q000601:surgery; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors
keywords: cardiovascular diseases; heart valve prosthesis; infant; perinatal mortality; pregnancy