title: Impact of Heart Disease on Maternal and Fetal Outcomes in Pregnant Women.
abstract: Pregnant women with underlying heart disease (HD) are at increased risk for adverse maternal and fetal outcomes. In this study, we sought to identify the risk and risk factors for adverse maternal and fetal events in pregnant women with underlying HD. Pregnant women referred for echocardiogram with known or suspected HD were categorized into those with (1) cardiomyopathy, (2) other HD (congenital, coronary, arrhythmia, or valvular), and (3) no HD. Primary outcome was major adverse cardiovascular events (MACE), defined as a composite of death, sustained arrhythmia, myocardial infarction, heart failure, and transient ischemic attack/stroke. Secondary outcome was fetal adverse clinical events (FACE), a composite of infant death, prematurity, underweight status, intracranial hemorrhage, and respiratory distress. Of the 173 pregnancies, 37 (21%) had cardiomyopathy, 65 (38%) had other HD, and 68 (39%) had no HD. MACE was higher in pregnancies with cardiomyopathy (p <0.001) because of higher rates of heart failure and cardiac arrest (up to 6 months postpartum, p <0.001 and 0.023, respectively). FACE rates were higher in cardiomyopathy pregnancies (p <0.001). In multivariate analysis, cardiomyopathy (odds ratio [OR] 11.5, 95% confidence interval [CI] 3.7 to 35.4), hypertension (OR 10.69, 95% CI 3.70 to 30.90), and arrhythmia (OR 7.6, 95% CI 2.1 to 27) were independently associated with higher MACE. Cardiomyopathy (OR 2.7, 95% CI 1.1 to 7.0) and hypertension (OR 3.6, 95% CI 1.4 to 9.0) were also independently predictive of higher FACE. In conclusion, pregnant women with cardiomyopathy had higher rates of adverse MACE and FACE rates. Cardiomyopathy, hypertension, and arrhythmia were independently associated with adverse cardiovascular and fetal clinical events, whereas other HD was not.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University, Stony Brook, New York.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Koutrolou-Sotiropoulou
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University, Stony Brook, New York.
authors.forename: Puja B
authors.initials: PB
authors.lastname: Parikh
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University, Stony Brook, New York.
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University, Stony Brook, New York.
authors.forename: Fabio V
authors.initials: FV
authors.lastname: Lima
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University, Stony Brook, New York.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University, Stony Brook, New York. Electronic address: kathleen.stergiopoulos@stonybrookmedicine.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Stergiopoulos
mesh_terms: D000328:Adult; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D009518:New York / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies