title: Maternal Cardiac Output and Fetal Doppler Predict Adverse Neonatal Outcomes in Pregnant Women With Heart Disease.
abstract: BACKGROUND
  The mechanistic basis of the proposed relationship between maternal cardiac output and neonatal complications in pregnant women with heart disease has not been well elucidated.
  
  
  RESULTS
  Pregnant women with cardiac disease and healthy pregnant women (controls) were prospectively followed with maternal echocardiography and obstetrical ultrasound scans at baseline, third trimester, and postpartum. Fetal/neonatal complications (death, small-for-gestational-age or low birthweight, prematurity, respiratory distress syndrome, or intraventricular hemorrhage) comprised the primary study outcome. One hundred and twenty-seven women with cardiac disease and 45 healthy controls were enrolled. Neonatal events occurred in 28 pregnancies and were more frequent in the heart disease group as compared with controls (n=26/127 or 21% versus n=2/45 or 4%; P=0.01). Multiple complications in an infant were counted as a single outcome event. Neonatal complications in the heart disease group were small-for-gestational-age/low birthweight (n=18), prematurity (n=14), and intraventricular hemorrhage/respiratory distress syndrome (n=5). Preexisting obstetric risk factors (P=0.003), maternal cardiac output decline from baseline to third trimester (P=0.017), and third trimester umbilical artery Doppler abnormalities (P<0.001) independently predicted neonatal complications and were incorporated into a novel risk index in which 0, 1, and >1 predictor corresponded to expected complication rates of 5%, 30%, and 76%, respectively.
  
  
  CONCLUSIONS
  Decline in maternal cardiac output during pregnancy and abnormal umbilical artery Doppler flows independently predict neonatal complications. These findings will enhance the identification of higher risk pregnancies that would benefit from close antenatal surveillance.
authors.affiliation: Pregnancy and Heart Disease Research Program and the Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada (R.M.W., C.K.S., C.S.L., J.M.C., S.C.S.) Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada (R.M.W., C.K.S., J.K., J.M., J.M.C., M.S., S.C.S.) Joint Department of Medical Imaging, University of Toronto, Ontario, Canada (R.M.W., A.T.).
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Wald
authors.affiliation: Pregnancy and Heart Disease Research Program and the Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada (R.M.W., C.K.S., C.S.L., J.M.C., S.C.S.) Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada (R.M.W., C.K.S., J.K., J.M., J.M.C., M.S., S.C.S.).
authors.forename: Candice K
authors.initials: CK
authors.lastname: Silversides
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada (R.M.W., C.K.S., J.K., J.M., J.M.C., M.S., S.C.S.).
authors.forename: John
authors.initials: J
authors.lastname: Kingdom
authors.affiliation: Joint Department of Medical Imaging, University of Toronto, Ontario, Canada (R.M.W., A.T.).
authors.forename: Ants
authors.initials: A
authors.lastname: Toi
authors.affiliation: Pregnancy and Heart Disease Research Program and the Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada (R.M.W., C.K.S., C.S.L., J.M.C., S.C.S.).
authors.forename: Cathy S
authors.initials: CS
authors.lastname: Lau
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada (R.M.W., C.K.S., J.K., J.M., J.M.C., M.S., S.C.S.).
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mason
authors.affiliation: Pregnancy and Heart Disease Research Program and the Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada (R.M.W., C.K.S., C.S.L., J.M.C., S.C.S.) Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada (R.M.W., C.K.S., J.K., J.M., J.M.C., M.S., S.C.S.).
authors.forename: Jack M
authors.initials: JM
authors.lastname: Colman
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada (R.M.W., C.K.S., J.K., J.M., J.M.C., M.S., S.C.S.).
authors.forename: Mathew
authors.initials: M
authors.lastname: Sermer
authors.affiliation: Pregnancy and Heart Disease Research Program and the Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada (R.M.W., C.K.S., C.S.L., J.M.C., S.C.S.) Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada (R.M.W., C.K.S., J.K., J.M., J.M.C., M.S., S.C.S.) Division of Cardiology, Department of Medicine, University of Western Ontario, London, Ontario, Canada (S.C.S.).
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Siu
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D002302:Cardiac Output; D016022:Case-Control Studies; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000503:physiopathology; D050498:Live Birth; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011263:Pregnancy Trimester, Third; D047928:Premature Birth; D011446:Prospective Studies; D012039:Regional Blood Flow; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D018617:Ultrasonography, Doppler, Pulsed; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014469:Umbilical Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: cardiac output; heart diseases; pregnancy