title: Risk Prediction of Cardiovascular Complications in Pregnant Women With Heart Disease.
abstract: BACKGROUND
  Heart disease in pregnancy is the leading cause of non- obstetric maternal death. Few Brazilian studies have assessed the impact of heart disease during pregnancy.
  
  
  OBJECTIVE
  To determine the risk factors associated with cardiovascular and neonatal complications.
  
  
  METHODS
  We evaluated 132 pregnant women with heart disease at a High-Risk Pregnancy outpatient clinic, from January 2005 to July 2010. Variables that could influence the maternal-fetal outcome were selected: age, parity, smoking, etiology and severity of the disease, previous cardiac complications, cyanosis, New York Heart Association (NYHA) functional class > II, left ventricular dysfunction/obstruction, arrhythmia, drug treatment change, time of prenatal care beginning and number of prenatal visits. The maternal-fetal risk index, Cardiac Disease in Pregnancy (CARPREG), was retrospectively calculated at the beginning of prenatal care, and patients were stratified in its three risk categories.
  
  
  RESULTS
  Rheumatic heart disease was the most prevalent (62.12%). The most frequent complications were heart failure (11.36%) and arrhythmias (6.82%). Factors associated with cardiovascular complications on multivariate analysis were: drug treatment change (p = 0.009), previous cardiac complications (p = 0.013) and NYHA class III on the first prenatal visit (p = 0.041). The cardiovascular complication rates were 15.22% in CARPREG 0, 16.42% in CARPREG 1, and 42.11% in CARPREG > 1, differing from those estimated by the original index: 5%, 27% and 75%, respectively. This sample had 26.36% of prematurity.
  
  
  CONCLUSIONS
  The cardiovascular complication risk factors in this population were drug treatment change, previous cardiac complications and NYHA class III at the beginning of prenatal care. The CARPREG index used in this sample composed mainly of patients with rheumatic heart disease overestimated the number of events in pregnant women classified as CARPREG 1 and > 1, and underestimated it in low-risk patients (CARPREG 0).
authors.affiliation: Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Luciana Carvalho
authors.initials: LC
authors.lastname: Martins
authors.affiliation: Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Claudia Maria Vilas
authors.initials: CM
authors.lastname: Freire
authors.affiliation: Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Carolina Andrade Bragança
authors.initials: CA
authors.lastname: Capuruçu
authors.affiliation: Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Maria do Carmo Pereira
authors.initials: Mdo C
authors.lastname: Nunes
authors.affiliation: Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Cezar Alencar de Lima
authors.initials: CA
authors.lastname: Rezende
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006331:Heart Diseases / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult