title: The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil.
abstract: To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity.
  
  
  
  Secondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively.
  
  
  
  In this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity.
authors.affiliation: Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Campanharo
authors.affiliation: Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil.
authors.forename: Jose G
authors.initials: JG
authors.lastname: Cecatti
authors.affiliation: Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil.
authors.forename: Samira M
authors.initials: SM
authors.lastname: Haddad
authors.affiliation: Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Parpinelli
authors.affiliation: Discipline of Cardiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Born
authors.affiliation: Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP) School of Medicine, Campinas, Brazil.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Costa
authors.affiliation: Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Rosiane
authors.initials: R
authors.lastname: Mattar
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D009017:Morbidity / Q000639:trends*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D055815:Young Adult