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Eur Heart J. 2019 Mar 25. pii: ehz136. doi: 10.1093/eurheartj/ehz136. [Epub ahead of print]

Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC).

Author information

1
Department of Cardiology, Erasmus Medical Center, CA Rotterdam, The Netherlands.
2
EURObservational Research Programme, European Society of Cardiology, 2035 route des Colles les Templiers, Sophia Antipolis, France.
3
Department of Obstetric Medicine, Imperial College London, Kensington, London, UK.
4
Department of Cardiology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium.
5
Department of Cardiology, UW School of Medicine, 1959 NE Pacific St, Seattle, WA, USA.
6
Department of Cardiology, McGill University Faculty of Medicine, 3605 Rue de la Montagne, Montréal, QC, Canada.
7
Department of Cardiology, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, Paris, France.
8
Department of Cardiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.
9
Department of Cardiology, University of British Columbia, Faculty of Medicine, 2312 Pandosy St, Kelowna, BC, Canada.
10
Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Private Bag, Observatory, South Africa.
11
Department of Cardiology, Royal Brisbane and Women's Hospital, Cnr Butterfield St and Bowen Bridge Road, Herston, QLD, Australia.
12
National Association of Hospital Cardiologists Research Center (ANMCO), Florence, Italy.
13
Department of Cardiology, Maria Cecilia Hospital, Via Madonna di Genova, 1, Cotignola RA, Italy.
14
Department of Obstetrics and Gynaecology, University of Southern California, Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA, USA.
15
Department of Cardiology, University of East Anglia, Faculty of Medicine, Norwich Research Park, Norwich, UK.

Abstract

AIMS:

Reducing maternal mortality is a World Health Organization (WHO) global health goal. Although maternal deaths due to haemorrhage and infection are declining, those related to heart disease are increasing and are now the most important cause in western countries. The aim is to define contemporary diagnosis-specific outcomes in pregnant women with heart disease.

METHODS AND RESULTS:

From 2007 to 2018, pregnant women with heart disease were prospectively enrolled in the Registry Of Pregnancy And Cardiac disease (ROPAC). Primary outcome was maternal mortality or heart failure, secondary outcomes were other cardiac, obstetric, and foetal complications. We enrolled 5739 pregnancies; the mean age was 29.5. Prevalent diagnoses were congenital (57%) and valvular heart disease (29%). Mortality (overall 0.6%) was highest in the pulmonary arterial hypertension (PAH) group (9%). Heart failure occurred in 11%, arrhythmias in 2%. Delivery was by Caesarean section in 44%. Obstetric and foetal complications occurred in 17% and 21%, respectively. The number of high-risk pregnancies (mWHO Class IV) increased from 0.7% in 2007-2010 to 10.9% in 2015-2018. Determinants for maternal complications were pre-pregnancy heart failure or New York Heart Association >II, systemic ejection fraction <40%, mWHO Class 4, and anticoagulants use. After an increase from 2007 to 2009, complication rates fell from 13.2% in 2010 to 9.3% in 2017.

CONCLUSION:

Rates of maternal mortality or heart failure were high in women with heart disease. However, from 2010, these rates declined despite the inclusion of more high-risk pregnancies. Highest complication rates occurred in women with PAH.

KEYWORDS:

Cardiomyopathies; Congenital Heart Disease; Maternal mortality; Pregnancy; Pregnancy complications

PMID:
30907409
DOI:
10.1093/eurheartj/ehz136

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