Pregnancy in women with cardiovascular disease in the guidelines era

Santacesaria, Sara; Cataldo, Stefania; Annoni, G; Corbella, Paola; Fiocchi, Stefano; Vignati, Gabriele M.

doi:10.2459/jcm.0000000000000352

Cited by 4 publications

(10 citation statements)

References 22 publications

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“…We observed an overall rate of cardiac complications of 10.7%, in line with published literature reporting rates ranging from 9% to 16% 9 11 19 20…”

Section: Discussionsupporting

confidence: 90%

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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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“…We observed an overall rate of cardiac complications of 10.7%, in line with published literature reporting rates ranging from 9% to 16% 9 11 19 20…”

Section: Discussionsupporting

confidence: 90%

“…The most common adverse event found in our cohort was HF, with an overall rate of 7.1%, similarly to published data 11 19–21. Importantly, 7/14 cases of HF occurred in the first 3 days after delivery, which are characterised by the largest haemodynamic changes,22 23 with the remaining cases all within 10 days post partum.…”

Section: Discussionsupporting

confidence: 87%

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

et al. 2022

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“…As a consequence, the maternal mortality was quite high as compared to those in the previous studies from developed countries. 8 , 9 However, there was not much variance from that of developing countries. 12 , 13…”

Section: Discussionmentioning

confidence: 99%

“…A recent study from Italy also found high complication rates in higher classes, 5% in class I and II and 31% in class III and IV. 8 Detailed analysis of cardiovascular events found that congestive heart failure was the most common complication. This is similar to previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…One study from Italy reported lower mean birth weight, higher stillbirth rate and higher neonatal intensive care unit admission in the higher classes (III and IV) as compared to those of the lower classes (I and II). 8 This is supposedly to be directly resulting from poor maternal cardiac function and severe maternal complications, which led to fetal jeopardy and also a reduction in placental supply for nutrients and oxygenation. In our study, stillbirth rate was low, so it could not show the statistical differences among the four classes.…”

Section: Discussionmentioning

confidence: 99%

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Validation of modified World Health Organization classification for pregnant women with heart disease in a tertiary care center in southern Thailand

Suwanrath¹,

Thongphanang²,

Pinjaroen³

et al. 2018

IJWH

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PurposeTo validate the modified World Health Organization (WHO) classification in pregnant women with congenital and acquired heart diseases.Patients and methodsThe database of pregnant women with heart disease, who delivered at Songklanagarind Hospital between January 1995 and December 2016, was retrieved from the Statistical Unit, Department of Obstetrics and Gynecology, along with the Hospital Information System of Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University. Each patient was retrospectively classified according to the modified WHO classification of maternal cardiovascular risk. Comparison of maternal and fetal outcomes among the modified WHO classes were analyzed using the chi-square test or Fisher’s exact test and one-way ANOVA test. A p-value of <0.05 was considered statistically significant.ResultsA total of 331 cases were studied: 157 cases with congenital heart disease and 174 cases with acquired heart disease. There were 48, 173, 32 and 78 cases in the modified WHO class I, II, III and IV, respectively. Congestive heart failure was the most common complication. The overall maternal mortality rate was 3.6%, all of which were in the modified WHO class IV. Maternal cardiovascular events occurred in 24.2% of cases, increasing rates with higher modified WHO class: 4.2%, 15.0%, 25.0% and 56.4% in class I, II, III and IV, respectively (p<0.001). Adverse fetal outcomes including preterm delivery, low birth weight, small for gestational age and neonatal intensive care unit admission were also significantly increased in class III and IV (p<0.05).ConclusionThe modified WHO classification is useful not only for obtaining a cardiovascular risk assessment in pregnant women with heart disease but also for predicting adverse fetal outcomes. It must, therefore, be implemented into routine care service at all levels of health care systems.

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Chest conformation spuriously influences strain parameters of myocardial contractile function in healthy pregnant women

Sonaglioni¹,

Esposito

Caruso

et al. 2021

Journal of Cardiovascular Medicine

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Aims Left ventricular (LV) contractility during noncomplicated pregnancy has been previously investigated by two-dimensional speckle-tracking echocardiography (2D-STE), with conflicting results. Chest abnormalities might affect myocardial strain parameters, yet this issue has not been previously investigated during pregnancy. We evaluated the influence of chest conformation on myocardial strain parameters in healthy pregnant women.Methods Between October 2019 and February 2020, 50 healthy pregnant women (32.3 W 4.0 years old) were consecutively studied. They underwent obstetric visit, assessment of chest shape by modified Haller index (MHI; chest transverse diameter over the distance between sternum and spine) and transthoracic echocardiography implemented with 2D-STE analysis of all myocardial strain parameters in the first trimester (12-14 weeks), third trimester (36-38 weeks) and 6-9 weeks after delivery.Results LV ejection fraction remained substantially unchanged (P U 0.13), while on the average all myocardial strain parameters showed a small but significant decrease during pregnancy, and recovered postpartum (all P < 0.001). Women with concave-shaped chest wall (MHI > 2.5, n U 29), and those with normal chest conformation (MHI< -2.5, n U 21) were then separately analyzed. Pregnant women with MHI above 2.5, but not those with MHI 2.5 or less, showed a progressive but reversible decrease in all myocardial strain parameters (all P < 0.001). MHI was strongly correlated with LV global longitudinal strain (r U S0.87) and LV global circumferential strain (r U S0.83) in the third trimester of pregnancy.Conclusion Myocardial strain impairment during healthy pregnancy may not reflect intrinsic myocardial dysfunction but rather intraventricular dyssynchrony related to a narrow antero-posterior chest diameter and rise in the diaphragm, with consequent extrinsic myocardial compression.

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Pregnancy in women with cardiovascular disease in the guidelines era

Cited by 4 publications

References 22 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

Validation of modified World Health Organization classification for pregnant women with heart disease in a tertiary care center in southern Thailand

Chest conformation spuriously influences strain parameters of myocardial contractile function in healthy pregnant women

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