Incidence of pre‐eclampsia and other perinatal complications among pregnant women with congenital heart disease: systematic review and meta‐analysis

Martínez-Portilla, Raigam Jafet; Poon, Liona C.; Benítez-Quintanilla, Leticia; Sotiriadis, Alexandros; López, Marta; Lip‐Sosa, D.L.; Figueras, F.

doi:10.1002/uog.22174

Cited by 11 publications

(6 citation statements)

References 93 publications

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“…A recent meta-analysis could demonstrate a weak association between maternal CHD and pre-eclampsia, except for aortic stenosis and pulmonary atresia. 29 Their meta-regression analysis for CoA of pre-eclampsia on a total of 13 studies, including eclampsia and HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) in women with CHD, could not find a significant correlation ( P = 0.094), though with heterogeneity in variability across studies considered to be moderate ( I 2 = 69%). 30 The rate of PE, eclampsia, and HELLP syndrome taken together was 4.3% (in a total of 33 included studies).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Our results are comparable with results from a meta-analysis, where pre-eclampsia affected 3.1% of pregnancies in women with CHD. 21 Surprisingly, aortic coarctation, which is often complicated by chronic hypertension, 3 did not increase the risk of pre-eclampsia. Although another study reported differences between complex and non-complex CHD (7.3 vs. 5.7%), the prevalence of pre-eclampsia was <5% even in complex CHD in our cohort, except for pulmonary atresia (15.6%).…”

Section: Discussionmentioning

confidence: 97%

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

Ramlakhan

Malhamé

Marelli

et al. 2022

European Heart Journal

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Aims Hypertensive disorders of pregnancy (HDP) occur in 10% of pregnancies in the general population, pre-eclampsia specifically in 3–5%. Hypertensive disorders of pregnancy may have a high prevalence in, and be poorly tolerated by, women with heart disease. Methods and results The prevalence and outcomes of HDP (chronic hypertension, gestational hypertension or pre-eclampsia) were assessed in the ESC EORP ROPAC (n = 5739), a worldwide prospective registry of pregnancies in women with heart disease. The overall prevalence of HDP was 10.3%, made up of chronic hypertension (5.9%), gestational hypertension (1.3%), and pre-eclampsia (3%), with significant differences between the types of underlying heart disease (P < 0.05). Pre-eclampsia rates were highest in women with pulmonary arterial hypertension (PAH) (11.1%), cardiomyopathy (CMP) (7.1%), and ischaemic heart disease (IHD) (6.3%). Maternal mortality was 1.4 and 0.6% in women with vs. without HDP (P = 0.04), and even 3.5% in those with pre-eclampsia. All pre-eclampsia-related deaths were post-partum and 50% were due to heart failure. Heart failure occurred in 18.5 vs. 10.6% of women with vs. without HDP (P < 0.001) and in 29.1% of those with pre-eclampsia. Perinatal mortality was 3.1 vs. 1.7% in women with vs. without HDP (P = 0.019) and 4.7% in those with pre-eclampsia. Conclusion Hypertensive disorders of pregnancy and pre-eclampsia rates were higher in women with CMP, IHD, and PAH than in the general population. Adverse outcomes were increased in women with HDP, and maternal mortality was strikingly high in women with pre-eclampsia. The combination of HDP and heart disease should prompt close surveillance in a multidisciplinary context and the diagnosis of pre-eclampsia requires hospital admission and continued monitoring during the post-partum period.

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“…Preeclampsia (PE) and related hypertensive disorders of pregnancy complicate 2–5 percentages of all pregnancies in developed countries and are major contributors to maternal and neonatal morbidities and mortalities [ 1 , 2 ]. PE and eclampsia rank second or third in all worldwide ranking of maternal death causes.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Selenium Supplementation on Clinical Outcomes, Metabolic Profiles, and Pulsatility Index of the Uterine Artery in High-Risk Mothers in Terms of Preeclampsia Screening with Quadruple Test: a Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Mesdaghinia

Shahin

Ghaderi

et al. 2022

Biol Trace Elem Res

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Data on the effects of selenium (Se) supplementation on clinical outcomes, metabolic profiles, and pulsatility index (PI) in high-risk mothers in terms of preeclampsia (PE) screening with quadruple tests are scarce. This study evaluated the effects of Se supplementation on clinical outcomes, metabolic profiles, and uterine artery PI on Doppler ultrasound in high-risk mothers in terms of PE screening with quad marker. The current randomized, double-blind, placebo-controlled trial was conducted among 60 high-risk pregnant women screening for PE with quad tests. Participants were randomly allocated into two groups (30 participants each group), received either 200 µg/day Se supplements (as Se amino acid chelate) or placebo from 16 to 18 weeks of pregnancy for 12 weeks. Clinical outcomes, metabolic profiles, and uterine artery PI were assessed at baseline and at the end of trial. Se supplementation resulted in a significant elevation in serum Se levels (β 22.25 µg/dl; 95% CI, 18.3, 26.1; P < 0.001) compared with the placebo. Also, Se supplementation resulted in a significant elevation in total antioxidant capacity (β 82.88 mmol/L; 95% CI, 3.03, 162.73; P = 0.04), and total glutathione (β 71.35 µmol/L; 95% CI, 5.76, 136.94; P = 0.03), and a significant reduction in high-sensitivity C-reactive protein levels (β − 1.52; 95% CI, − 2.91, − 0.14; P = 0.03) compared with the placebo. Additionally, Se supplementation significantly decreased PI of the uterine artery in Doppler ultrasound (β − 0.09; 95% CI, − 0.14, − 0.04; P = 0.04), and a significant improvement in depression (β − 5.63; 95% CI, − 6.97, − 4.28; P < 0.001), anxiety (β − 1.99; 95% CI, − 2.56, − 1.42; P < 0.001), and sleep quality (β − 1.97; 95% CI, − 2.47, − 1.46; P < 0.001). Se supplementation for 12 weeks in high-risk pregnant women in terms of PE screening with quad marker had beneficial effects on serum Se level, some metabolic profiles, uterine artery PI, and mental health. IRCT Registration: htpp:// www.irct.ir ; identifier IRCT20200608047701N1.

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Incidence of pre‐eclampsia and other perinatal complications among pregnant women with congenital heart disease: systematic review and meta‐analysis

Cited by 11 publications

References 93 publications

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

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

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

The Effect of Selenium Supplementation on Clinical Outcomes, Metabolic Profiles, and Pulsatility Index of the Uterine Artery in High-Risk Mothers in Terms of Preeclampsia Screening with Quadruple Test: a Randomized, Double-Blind, Placebo-Controlled Clinical Trial

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