title: Pregnancy in women with cardiovascular disease in the guidelines era: an Italian single-center experience.
abstract: OBJECTIVE
  The aim of the present study is to determine pregnancy outcome with regard to the risk class and the modality way of referral to our joint Cardiac Obstetric Clinic.
  
  
  METHODS
  This is a prospective observational study. Patients referred to our clinic between 2011 and 2014 were included. Reason and timing for referral were recorded. Two groups were identified: women who were known to have cardiac disease before referral (group I) and women who were not (group II). Pregnancies were managed as recommended by the ESC Guidelines. Cardiac events were defined as death, heart failure requiring treatment, documented tachyarrhythmias, thromboembolic events and need for urgent endovascular procedures or surgery.
  
  
  RESULTS
  Of the 110 pregnancies, 51 (47%) were in group I and 57 (53%) in group II. Congenital (44%) and valvular (27%) diseases were the most frequent diagnosis. Thirty-two percent of patients were in WHO risk classes III-IV. Thirty percent were referred for symptoms, 70% for risk assessment. Women in group II were evaluated later in pregnancy than those in group I (25.6 ± 9 vs. 21.4 ± 9; P < 0.01). Cardiovascular events occurred in 15 (13.6%) pregnancies and were more common in WHO risk classes III-IV (11, P < 0.001), in group II (12, P= 0.02) and in patients referred for symptoms (11, P < 0.001). Stillbirths occurred only in classes III-IV (three pregnant, 2.7%).
  
  
  CONCLUSIONS
  There was no maternal or neonatal mortality and an overall acceptable incidence of cardiovascular events but a relevant percentage of pregnant were first referred late and/or for the onset of symptoms. Events were more frequent in these patients. Further efforts are needed to optimize referral to specialized centers.
authors.affiliation: aPediatric and Congenital Heart Disease Unit bObstetric Department cNeonatal Intensive Care Unit, Niguarda Hospital, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Santacesaria
authors.forename: Stefania
authors.initials: S
authors.lastname: Cataldo
authors.forename: Giuseppe A
authors.initials: GA
authors.lastname: Annoni
authors.forename: Paola
authors.initials: P
authors.lastname: Corbella
authors.forename: Stefano
authors.initials: S
authors.lastname: Fiocchi
authors.forename: Gabriele M
authors.initials: GM
authors.lastname: Vignati
mesh_terms: D000328:Adult; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology*; D006801:Humans; D007558:Italy; D008428:Maternal Mortality; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000145:classification* / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D014944:World Health Organization; D055815:Young Adult