Cardiovascular Care for Pregnant Women With Cardiovascular Disease

Magun, Ella; DeFilippis, Ersilia M.; Noble, Sarah C.; LaSala, Anita; Waksmonski, Carol A.; D’Alton, Mary E.; Haythe, Jennifer

doi:10.1016/j.jacc.2020.08.071

Cited by 56 publications

(33 citation statements)

References 24 publications

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“…Of note, both the 2018 ESC and 2019 American College of Obstetrics and Gynecology (ACOG) guidelines suggest to consider induction of labour at 39–40 weeks’ gestation in all these women 5 12. This finding is in line with the relatively low rate of labour induction identified in our cohort (23.3%) 15…”

Section: Discussionsupporting

confidence: 82%

“…The 2018 ESC guidelines introduced for the first time the concept of the Pregnancy Heart team for improving assessment of pregnant women with HD, thus possibly decreasing the odds of cardiac complications 5 15 16. A multidisciplinary team is pivotal for adequate risk assessment, as this requires to combine the mWHO classification with predictors, a detailed lesion-specific evaluation, and expert clinical judgement of the potential effects of pregnancy on patient’s HD 12 17 18…”

Section: Discussionmentioning

confidence: 99%

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Cardiac and obstetric outcomes in pregnant women with heart disease: appraisal of the 2018 mWHO classification

et al. 2022

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ObjectiveTo appraise the application of the 2018 European Society of Cardiology-adapted modified WHO (mWHO) classification to pregnant women with heart disease managed at our maternal–fetal medicine referral centre and to assess whether the lack of a multidisciplinary Pregnancy Heart team has influenced their outcomes.MethodsA retrospective cohort study including all pregnancies with heart disease managed at our centre between June 2011 and December 2020. Cardiac conditions were categorised in five classes according to the mWHO classification. An additional class, named X, was created for conditions not included in this classification. Outcomes were compared among all classes and factors potentially associated to cardiac complications were assessed.ResultsWe identified 162 women with 197 pregnancies, for a prevalence of 0.7%. Thirty-eight (19.3%) gestations were included in class X. Caesarean section was performed in 64.9% pregnancies in class X, a rate similar to that of class II, II-III, and III/IV, and mostly for obstetric indications; in turn, it was more commonly performed for cardiology reasons in class II–III and III/IV. Cardiac complications occurred in 10.7%, with class X and II pregnancies showing the highest number of events (n=30.8% and 34.6%, respectively). Multiple gestation and urgent caesarean section associated with a 5-fold and 6.5-fold increase in complication rates.ConclusionsEven in a maternal–fetal medicine referral centre, the lack of a multidisciplinary team approach to women with heart disease may negatively impact their outcomes.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Cardiac and obstetric outcomes in pregnant women with heart disease: appraisal of the 2018 mWHO classification

et al. 2022

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“…With a decade of experience, our Cardio-Obstetrics program illustrates the successful creation and implementation of a multidisciplinary model of care for pregnant women with preexisting cardiac disease. Our Cardio-Obstetrics program is similar to others that have been developed at larger academic centers 21,22 and follows recent recommendations to frame the care of pregnant women with CVD within a joint model of care in order to improve maternal outcomes. 19,23 As a level IV Regional Perinatal Health Center, 24 we have similarly developed other perinatal programs to care for pregnant women with pregestational diabetes, renal disease, and neurologic disorders, with favorable outcomes.…”

Section: Future Directionsmentioning

confidence: 98%

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

Quiñones¹,

Walheim²,

Mann³

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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“…92 More comparative studies should be performed in order to define the most accurate risk index for pregnant women with heart disease. 91,95 The role of comprehensive cardio-obstetric clinics The concept of multidisciplinary cardio-obstetric clinics (Figure 10) has evolved and been applied in several countries, with extremely encouraging results [96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112][113][114] and excellent survival rates of mothers even with complex diseases, and their offspring. 24 However, the need for cardio-obstetric clinics remains un-met, with most programs to be found in developed countries and with only a few centers continuing follow-up long term.…”

Section: Risk Stratificationmentioning

confidence: 99%

Cardiovascular adverse events in pregnancy: A global perspective

Kotit

Yacoub

2021

gcsp

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Pregnant women with heart disease are vulnerable to many adverse cardiovascular events (AE). AEs during and after pregnancy continue to be important causes of maternal mortality and morbidity worldwide, with huge variations in burden in different countries and regions. These AEs are classified as having direct or indirect causes, depending on whether they are directly caused by pregnancy or due to some pre-existing disease and/or non-obstetric cause, respectively.The risks continue throughout pregnancy and even after childbirth. Apart from immediate complications during pregnancy, there is increasing evidence of a significant link between several events and the risk of cardiovascular disease (CVD) later in life.A significant number of pregnancy-related deaths caused by cardiovascular disease are preventable. This prevention can be realized through increasing awareness of cardiovascular AE in pregnancy, coupled with the application of strategies for prevention and treatment. Knowledge of the risks associated with CVD and pregnancy is of extreme importance in that regard.We discuss the global distribution of cardiovascular maternal mortality, adverse events during and after pregnancy, their predictors and risk stratification. In addition, we enumerate possible solutions, particularly the role of cardio-obstetric clinics.

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Cardiovascular Care for Pregnant Women With Cardiovascular Disease

Cited by 56 publications

References 24 publications

Cardiac and obstetric outcomes in pregnant women with heart disease: appraisal of the 2018 mWHO classification

Cardiac and obstetric outcomes in pregnant women with heart disease: appraisal of the 2018 mWHO classification

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

Cardiovascular adverse events in pregnancy: A global perspective

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