Predictors of maternal and neonatal complications in patients with severe valve heart disease during pregnancy: a retrospective cohort study

Abstract

Background: The severe valve disease especially stenosis is a contraindication to conception according to World Health Organization. This situation is still encountered in countries with a high rheumatic fever prevalence. The objective of this study is to determine the predictors of maternal cardiac, obstetric and neonatal complications.Methods: This is an observational study of all pregnant women with severe valvulopathy, delivered between 2010 and 2017.Results: We included 60 pregnancies in 54 women. Cardiac complications occurred in 37 patients (61%). In multivariate analysis, the predictors of these complications were parity (OR = 2.41, p = 0.023), revelation of valvulopathy by pregnancy (OR = 6.34, p = 0.025), severe mitral stenosis (OR= 6.84, p= 0.035) and systolic pulmonary arterial pressure (OR = 1.08, p= 0.01). Obstetrical complications were noted in 19 women (31.8%). The predictors of these complications were primiparity (OR = 5.22, p = 0.032), multiple valve disease (OR = 5.26, p = 0.028), systolic pulmonary arterial pressure (OR = 1.04, p = 0.04) and treatment with vitamin K antagonist (OR = 8.71, p = 0.04). Neonatal complications were noted in 39% of new-borns. The predictors of these complications were the occurrence of obstetric complications (OR = 15.48, p = 0.001) and the revelation of valvulopathy by pregnancy (OR = 6.95, p = 0.017).Conclusions: The revelation of valve disease by pregnancy is a predictor not only of cardiac complication but also of neonatal complications, thus valve disease screening during pre-conceptional counselling is so crucial.