title: Incidence and predictors of obstetric and fetal complications in women with structural heart disease.
abstract: Women with cardiac disease becoming pregnant have an increased risk of obstetric and fetal events. The aim of this study was to study the incidence of events, to validate the modified WHO (mWHO) risk classification and to search for event-specific predictors.
  
  
  
  The Registry Of Pregnancy And Cardiac disease is a worldwide ongoing prospective registry that has enrolled 2742 pregnancies in women with known cardiac disease (mainly congenital and valvular disease) before pregnancy, from January 2008 up to April 2014.
  
  
  
  Mean age was 28.2±5.5 years, 45% were nulliparous and 33.3% came from emerging countries. Obstetric events occurred in 231 pregnancies (8.4%). Fetal events occurred in 651 pregnancies (23.7%). The mWHO classification performed poorly in predicting obstetric (c-statistic=0.601) and fetal events (c-statistic=0.561). In multivariable analysis, aortic valve disease was associated with pre-eclampsia (OR=2.6, 95%CI=1.3 to 5.5). Congenital heart disease (CHD) was associated with spontaneous preterm birth (OR=1.8, 95%CI=1.2 to 2.7). Complex CHD was associated with small-for-gestational-age neonates (OR=2.3, 95%CI=1.5 to 3.5). Multiple gestation was the strongest predictor of fetal events: fetal/neonatal death (OR=6.4, 95%CI=2.5 to 16), spontaneous preterm birth (OR=5.3, 95%CI=2.5 to 11) and small-for-gestational age (OR=5.0, 95%CI=2.5 to 9.8).
  
  
  
  The mWHO classification is not suitable for prediction of obstetric and fetal events in women with cardiac disease. Maternal complex CHD was independently associated with fetal growth restriction and aortic valve disease with pre-eclampsia, potentially offering an insight into the pathophysiology of these pregnancy complications. The increased rates of adverse obstetric and fetal outcomes in women with pre-existing heart disease should be highlighted during counselling.
authors.affiliation: Department of Cardiology, ErasmusMC, Rotterdam, The Netherlands.
authors.forename: Iris M
authors.initials: IM
authors.lastname: van Hagen
authors.affiliation: Department of Cardiology, ErasmusMC, Rotterdam, The Netherlands.|Fellow, of the European Society of Cardiology, Sophia Antipolis, France.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Department of Internal Medicine - Department of Gynaecology and Obstetrics, Sant'Anna Hospital, Citt della Salute e della Scienza, Turin, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Donvito
authors.affiliation: Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors.forename: Csilla
authors.initials: C
authors.lastname: Liptai
authors.affiliation: Department of Cardiology, CHU Brugmann, Brussels, Belgium.
authors.forename: Marielle
authors.initials: M
authors.lastname: Morissens
authors.affiliation: Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Murphy
authors.affiliation: Department of Cardiology, Hospital Vall DHebron, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Galian
authors.affiliation: Department of cardiology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
authors.forename: Nooshin Mohd
authors.initials: NM
authors.lastname: Bazargani
authors.affiliation: Obstetrics and Gynaecology, ErasmusMC, Rotterdam, The Netherlands.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cornette
authors.affiliation: Department of cardiology, Norwich Medical school, University of East Anglia, Norwich, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Hall
authors.affiliation: Imperial College London, Chelsea and Westminster Hospital, London, UK.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Johnson
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012042:Registries; D012307:Risk Factors; D055815:Young Adult
keywords: Congenital heart disease; Prediction; Pregnancy; Valvular heart disease