Original Research
Impact of type of maternal cardiovascular disease on pregnancy outcomes among women managed in a multidisciplinary cardio-obstetrics program

https://doi.org/10.1016/j.ajogmf.2021.100377Get rights and content

BACKGROUND

Maternal cardiovascular disease complicates up to 4% of pregnancies in the United States. Knowledge regarding the impact of the cardiovascular disease category is limited.

OBJECTIVE

The purpose of this study was to compare the maternal and neonatal outcomes among women with different types of cardiovascular diseases managed in a multidisciplinary program.

STUDY DESIGN

This was a retrospective cohort study of patients with documented structural or functional cardiovascular disease who received care in a multidisciplinary program with maternal-fetal medicine and cardiology specialists at a single institution between March 2010 and November 2019. Women were categorized as having congenital heart disease, acquired heart disease, arrhythmias and channelopathies, or aortopathies. Women were excluded from the pregnancy outcome analysis if they never became pregnant or delivered at a different institution. The outcomes were analyzed according to the disease category using univariate techniques.

RESULTS

A total of 232 women with 253 pregnancies met the inclusion criteria for pregnancy outcome analysis. Of these, 77 (30.4%) had congenital heart disease, 63 (24.9%) had acquired heart disease, 94 (37.2%) had arrhythmias or channelopathies, and 19 (7.5%) had aortopathies. Obesity and hypertension were more common among women with acquired heart disease, and women with acquired heart disease and arrhythmias had higher Cardiac Disease in Pregnancy II scores. Most of the pregnancies had good maternal and neonatal outcomes. Preeclampsia occurred more commonly in women with acquired heart disease (27% among those with acquired heart disease vs 10.4% among those with congenital heart disease, 13.8% among those with arrhythmias or channelopathies, and 0% among those with aortopathies; P=.009). Indicated preterm birth was highest among women with acquired heart disease (15.9%). Significant postpartum arrhythmias occurred in 2.4% of women. Preconception counseling was underutilized.

CONCLUSION

Most women with preexisting cardiovascular disease experienced good pregnancy and neonatal outcomes when managed in a specialized, multidisciplinary program. Women with acquired heart disease were at highest risk for pregnancy complications such as preeclampsia and preterm birth.

Introduction

Cardiovascular disease (CVD) complicates up to 4% of pregnancies in the United States and is the leading cause of maternal deaths related to hypertension and preeclampsia.1,2 Over the past decade, the number of women with congenital heart disease (CHD) delivering children has increased largely because of the advances in pediatric care.3,4 The prevalence of acquired cardiovascular disease (particularly coronary artery disease) is also increasing among reproductive-aged women owing to the higher rates of obesity, hypertension, and diabetes.5 Because of the increasing frequency and impact of CVD in pregnant women, the American College of Cardiology, the American Heart Association (AHA), the European Society of Cardiology, and the Canadian Cardiovascular Society have all established guidelines for the management of CVD during pregnancy,4, 5, 6, 7 highlighting the importance of multidisciplinary care for pregnant women with CVD.7

Our cardio-obstetrics program was conceived and developed at the Lehigh Valley Health Network (LVHN) in 2010 before the establishment of the above guidelines. We previously published our initial 4 year referral patterns as a quality improvement study and included all women referred to the program (173), both with and without documented CVD.8 The objective of this study was to compare the pregnancy outcomes among women with different CVD types (CHD, acquired heart disease [AHD], arrhythmias or channelopathies, or aortopathies) who were followed in this multidisciplinary program since 2010 and who had diagnostic confirmation of CVD. We hypothesized that the cardiac and obstetrical outcomes among women with preexisting CVD would vary depending on the CVD category.

Section snippets

Materials and Methods

This was a retrospective cohort study of patients with diagnostic evidence of structural or functional CVD who were seen as part of the cardio-obstetrics program at LVHN from its inception in March 2010 to November 2019. The LVHN is a 1700 bed network of 8 hospital campuses in eastern Pennsylvania. LVHN is a branch medical campus affiliate of the University of South Florida Morsani College of Medicine and is a level IV Regional Perinatal Health Center with approximately 4700 deliveries per

Results

There were 577 visits by women who were seen as part of the cardio-obstetrics program between March 2010 and November 2019; 324 were excluded primarily because of symptoms without diagnostic evidence of structural or functional CVD, giving a final cohort of 232 women with 253 pregnancies who were followed in the program during the study period (Figure). There were 2 sets of twin gestations, 17 women with 2 pregnancies, and 2 women with 3 pregnancies. For the 19 women with more than 1 pregnancy

Principal findings of the study

Overall, we found that women whose pregnancies were complicated by CVD had favorable outcomes when managed in a specialized, multidisciplinary program with low rates of preterm birth, growth restriction, and serious cardiac events. We also found that women with AHD had an increased risk for preeclampsia (explained by chronic hypertension and obesity), preterm birth (primarily owing to the increased rates of preeclampsia), and a trend toward an increased rate of cesarean deliveries when compared

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  • Cited by (0)

    The authors report no conflict of interest.

    The authors report no funding sources.

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