title: Ten Years' Experience of Pregnancy Outcomes in Women with Cardiac Valvulopathies: Are Valve Prostheses Worst?
abstract: OBJECTIVE
  The population of pregnant women with valvular heart disease (VHD), and in particular with valvular heart prostheses (VHPs), represents a unique patient group where data are scarce, and where there is an increased risk for adverse maternal and obstetric events. The study aim was to assess the experience of a tertiary center with regards to cardiac and pregnancy outcomes in women with VHD, comparing VHPs with other VHD pathologies.
  
  
  METHODS
  A retrospective analysis of 84 pregnancies in women with VHD (mean age 27.5 ± 5.5 years) was carried out over a 10-year period. Twenty-three pregnancies with VHPs (group A) and 61 with other VHD pathologies (group B) were identified and their cardiac, obstetric, and neonatal outcomes evaluated.
  
  
  RESULTS
  At the start of pregnancy, group A included more patients with an impaired left ventricular ejection fraction (LVEF) (15.8% versus 3.9%, p = 0.014), with a previous history of cardiac medication (82.6% versus 29.5%, p = 0.000), and with arrhythmic or ischemic events (18.2% versus 4.9%, p = 0.076). A deterioration in NYHA functional class was the most common cardiac complication (8.3%), and in 7.1% of patients it was necessary to initiate some form of cardiac medication. No maternal deaths were recorded. Group A presented significantly more hemorrhagic and thrombotic complications; all of these events were in women receiving low-molecular-weight heparin. There were 95.5% live births, with a medium birth weight of 3068 ± 498 g. In the VHP group there was also a higher incidence of spontaneous abortion (26.1 versus 3.3, p = 0.005), newborns small for gestational age (30.0 versus 0.4, p = 0.07) and mean Apgar score < 7 (16.7 versus 0.0, p = 0.031). Warfarin embryopathy was observed in one case.
  
  
  CONCLUSIONS
  With the multidisciplinary care provided, pregnancy was relatively well tolerated and successful. However, the presence of a VHP remains a challenging condition that is associated with elevated maternal and fetal morbidity. A worse baseline cardiac status of the mother, as well as anticoagulation issues, were determinants for these findings.
authors.forename: André Viveiros
authors.initials: AV
authors.lastname: Monteiro
authors.forename: Joana
authors.initials: J
authors.lastname: Rebelo
authors.forename: Lino
authors.initials: L
authors.lastname: Patricio
authors.forename: Ana
authors.initials: A
authors.lastname: Campos
authors.forename: Augusta
authors.initials: A
authors.lastname: Borges
authors.forename: Rui Cruz
authors.initials: RC
authors.lastname: Ferreira
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D001034:Apgar Score; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology*; D006350:Heart Valve Prosthesis; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011174:Portugal / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D013318:Stroke Volume
chemical_list: D002316:Cardiotonic Agents