Hypertensive disorders of pregnant women with heart disease: the ESC EORP ROPAC Registry

Ramlakhan, Karishma P.; Malhamé, Isabelle; Marelli, Ariane J.; Rutz, Tobias; Goland, Sorel; Franx, Arie; Sliwa, Karen; Elkayam, Uri; Johnson, Mark R.; Hall, Roger; Cornette, Jérôme; Roos‐Hesselink, Jolien W.

doi:10.1093/eurheartj/ehac308

Cited by 18 publications

(10 citation statements)

References 33 publications

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“…Although HDP contains different presentations of placental dysfunction, our study suggests that the risk of pre‐eclampsia was increased but not the risk of gestational hypertension alone. We did not include chronic hypertension as HDP, in contrast to Ramlakhan et al 13 . We observed a low prevalence of chronic hypertension, possibly influenced both by the use of beta‐blockers and limited recording of blood pressure in the first half of pregnancy.…”

Section: Discussionmentioning

confidence: 86%

“…In line with our results, Schlichting et al and Hardee et al have reported proportions of HDP in women with congenital heart disease of 15.4% and 10.3%-11.8%, respectively. 23,24 Using the Registry of Pregnancy and Cardiac Disease (ROPAC) Ramlakhan et al found that 10.3% of pregnancies in women with structural heart disease developed HDP, 13 and these women had increased risk of adverse maternal outcome and death. In contrast to our study, they included pregnancies with chronic hypertension (5.9%) as HDP.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 10 Impaired cardiac function before and during pregnancy is associated with reduced fetal growth. 11 There is evidence of higher risk of HDP among women with structural heart disease, 12 , 13 and women diagnosed with pre‐eclampsia have increased risk of CVD later in life. 14 Thus, the interplay between CVD and HDP is complex.…”

Section: Introductionmentioning

confidence: 99%

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Hypertensive disorders of pregnancy among women with cardiovascular disease in Norway: A historical cohort study

Langen,

Langesæter,

Gunnes

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionWomen with cardiovascular disease may be at increased risk of hypertensive disorders of pregnancy (HDP). We aimed to: (1) Investigate the occurrence of HDP in a cohort of pregnant women with cardiovascular disease and compare it with the occurrence in the general population. (2) Assess the association between maternal cardiovascular risk and risk of HDP.Material and methodsWe reviewed clinical data on a cohort of 901 pregnancies among 708 women with cardiovascular disease who were followed at the National Unit for Pregnancy and Heart Disease and gave birth at Oslo University Hospital between 2003 and 2018. The exposure under study was maternal cardiovascular risk, classified as low, moderate, or high based on a modified classification by the World Health Organization. The main outcome of interest was HDP, which included pre‐eclampsia and gestational hypertension. The proportion of HDP cases in the general population in the same period was extracted from the Medical Birth Registry of Norway. We used logistic regression to estimate crude and adjusted odds ratios (OR) of HDP, with associated 95% confidence intervals (CIs), for women with moderate‐ and high cardiovascular risk compared to women with low risk.ResultsThe occurrence of HDP in the study cohort was 12.1% (95% CI: 10.0%–14.4%) and varied between 8.7% (95% CI: 6.5%–11.3%) in the low‐risk group, 15.7% (95% CI: 11.1%–21.4%) in the moderate‐risk group, and 22.2% (95% CI: 15.1%–30.8%) in the high‐risk group. By contrast, the nationwide occurrence of HDP was 5.1% (95% CI: 5.1%–5.2%). In the study cohort, the proportions of pregnancies with gestational hypertension and pre‐eclampsia were similar (6.3% and 5.8%, respectively). Compared to pregnancies with low cardiovascular risk, the adjusted OR of HDP was 2.04 (95% CI: 1.21–3.44) in the moderate‐risk group and 2.99 (95% CI: 1.73–5.18) in the high‐risk group.ConclusionsThe occurrence of hypertensive disease of pregnancy in the study cohort was more than doubled compared to the general population in Norway. The risk of HDP increased with maternal cardiovascular risk group. We recommend taking into account maternal cardiovascular risk group when assessing risk and prophylaxis of HDP.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypertensive disorders of pregnancy among women with cardiovascular disease in Norway: A historical cohort study

Langen,

Langesæter,

Gunnes

et al. 2024

Acta Obstet Gynecol Scand

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“…All pre-eclampsia-related deaths occurred post-partum, most associated with heart failure. 9 Prevention of pre-eclampsia is gaining increased awareness, and the prescription of low-dose acetylsalicylic acid (ASA) to women with a high risk of pre-eclampsia in Norway may explain the decline in the prevalence in the general population in the last decade. Low-dose ASA is used to prevent cardiovascular diseases in high-risk populations, but women of reproductive age are rarely prescribed ASA for this indication.…”

Section: Introductionmentioning

confidence: 99%

High prevalence of pre-eclampsia in women with coarctation of the aorta

Gronningsaeter

Langesæter

Sørbye

et al. 2023

European Heart Journal Open

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Objective To study pregnancy outcomes in women with coarctation of the aorta (CoA) and associations to hypertensive disorders of pregnancy. Background Maternal morbidity and mortality are higher in women with heart disease and preeclampsia. Chronic hypertension, frequently encountered in CoA, is a risk factor for preeclampsia. Methods Clinical data from the National Unit for Pregnancy and Heart Disease database was reviewed for pregnant women with CoA from 2008 to 2021. The primary outcome was hypertensive pregnancy disorders. The secondary outcomes were other cardiovascular, obstetric, and fetal complications. Results Seventy-six patients were included, with a total of eighty-seven pregnancies. Seventeen (20%) patients were treated for chronic hypertension before pregnancy. Fifteen (20%) patients developed preeclampsia, and five (7%) had pregnancy-induced hypertension. Major adverse cardiac events developed in four (5%) patients, with no maternal or fetal mortality. Maternal age at first pregnancy (Odds ratio (OR) 1.37), BMI before first pregnancy (OR 1.77) and using ASA from the first trimester (OR 0.22) was statistically significantly associated with preeclampsia. At follow-up (median) eight years after pregnancy, twenty-nine (38%) patients had antihypertensive treatment, an increase of 16% compared to pre-pregnancy. Five (7%) patients had progression of aorta ascendens dilatation to >40mm, seven (9%) had an upper to lower systolic blood pressure BP gradient >20 mmHg, and six (8%) had received CoA reintervention. Conclusions Preeclampsia occurred in 20% of women with CoA in their first pregnancy. All preeclamptic patients received adequate antihypertensive treatment. All CoA patients was provided multidisciplinary management, including cardiologic follow-up, to optimize maternal-fetal outcomes.

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“…Por fim, a pré-eclâmpsia, uma condição gestacional de grande relevância clínica, emerge tipicamente após a vigésima semana de gravidez, elevando a pressão arterial da gestante para valores superiores a 140/90 mmHg. Além disso, a Pré-eclâmpsia frequentemente se associa a lesões em órgãos-alvo, tais como o fígado e os rins, proteinúria e disfunção uteroplacentária (RAMLAKHAN et al, 2022) Sendo uma das principais causas de morbidade e mortalidade materna e fetal, tal condição representa uma ameaça considerável à saúde durante a gestação. Assim, o presente estudo tem como objetivo relatar um caso clínico notável e desafiador envolvendo uma paciente gestante que apresenta a rara e complexa combinação de Anomalia de Ebstein, Comunicação Interatrial e pré-eclâmpsia.…”

Section: Introductionunclassified

Anomalia de Ebstein com comunicação interatrial em paciente gestante com pré-eclâmpsia: um raro relato de caso

Fialho,

Castro,

Dias

et al. 2023

Braz. J. Hea. Rev.

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A Anomalia de Ebstein (AE) é uma cardiopatia congênita rara, ocorre em apenas 1% das más formações cardíacas. É uma alteração da implantação dos folhetos da valva tricúspide, ocorre o aumento do volume do átrio direito e a atrialização do ventrículo direito. Geralmente, possui uma evolução clínica lenta, com sintomas aparecendo em idade avançada. A comunicação interatrial (CIA), também consiste em uma cardiopatia congênita, do tipo acianótica, comumente assintomática, com prevalência de 5 a 10% de todas as cardiopatias, mais comum em mulheres. Baseia-se na formação de um “shunt” esquerdo-direito, podendo causar hiperfluxo da veia pulmonar. Por outro lado, a pré-eclâmpsia é uma complicação gestacional detectada na vigésima semana. É uma disfunção materno/placentária responsável por elevação da pressão arterial (> 140/90 mmHg), associada a lesão de órgão alvo, proteinúria ou disfunção útero/placentária. Neste estudo, o objetivo é relatar as complicações desenvolvidas durante a gestação em paciente que possuía essa rara associação de comorbidades. Paciente feminina, 20 anos, primigesta com 30 semanas e 4 dias, vista em USG obstétrico, com descontrole pressórico desde de o início da gestação. Cardiopata, sem acompanhamento, apresentando EA e IA (diagnóstico em laudo de 2008). Foi admitida em Unidade de Terapia Intensiva (UTI) com dispneia, saturação de O2 de 91%, pressão de 150/100 mmHg. Após estabilização, solicitados pareceres para cardiologia, obstetrícia e risco anestésico. USG obstétrico mostrou compartimento fetal alterado e relação cérebro/placentária alterada. No 2º dia, após corticoterapia, paciente retorna do centro-cirúrgico após cesariana, acoplada à ventilação mecânica invasiva, devido à descompensação. Radiografia pós-cirurgia mostrou pequeno derrame pleural bilateral. Mantida Cefalotina por mais 2 dias. No dia 3, TC de tórax revelou derrame persistente e consolidações, iniciando Ceftriaxone e Clindamicina. Noradrenalina iniciada após descompensação hemodinâmica. No dia 6, após teste de respiração espontânea bem-sucedido, o ecocardiograma evidenciou AE, insuficiência tricúspide acentuada e mitral leve. Sem critérios graves, a paciente foi transferida para a enfermaria para seguimento e término da antibioticoterapia. A gestação pode agravar riscos em pacientes com comorbidades raras como anomalias cardíacas congênitas. O acompanhamento específico é crucial e, em casos graves, a gravidez deve ser evitada.

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Hypertensive disorders of pregnant women with heart disease: the ESC EORP ROPAC Registry

Cited by 18 publications

References 33 publications

Hypertensive disorders of pregnancy among women with cardiovascular disease in Norway: A historical cohort study

Hypertensive disorders of pregnancy among women with cardiovascular disease in Norway: A historical cohort study

High prevalence of pre-eclampsia in women with coarctation of the aorta

Anomalia de Ebstein com comunicação interatrial em paciente gestante com pré-eclâmpsia: um raro relato de caso

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