BackgroundHeart disease in pregnancy is the leading cause of non- obstetric maternal
death. Few Brazilian studies have assessed the impact of heart disease
during pregnancy.ObjectiveTo determine the risk factors associated with cardiovascular and neonatal
complications.MethodsWe 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.ResultsRheumatic 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.ConclusionThe 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).
The group consisting of pregnant women with GDM or PE showed results for FMD significantly lower than the control group, suggesting possible endothelial injury in these patients.
Anatomical and functional changes in the venous system during pregnancy were detected by the air plethysmography and the vascular ultrasound in primigravidae. In pregnant women, the presence of venous stasis symptoms found an anatomical and functional substrate detected in the differences in diameter of the saphenous vein.
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