Pregnancy Outcomes in Women With Heart Disease

Silversides, Candice K.; Grewal, Jasmine; Mason, Jennifer; Sermer, Mathew; Kiess, Marla; Rychel, Valerie; Wald, Rachel M.; Colman, Jack M.; Siu, Samuel C.

doi:10.1016/j.jacc.2018.02.076

Cited by 476 publications

(365 citation statements)

References 29 publications

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“…To our knowledge, this study was the first to present Canadian population‐based trends of pregnancy rates and delivery outcomes among women of reproductive age with CHD over a period of 13 years. Indeed, several prior studies on pregnancy outcomes in women with CHD have included women already known to be pregnant, precluding estimation of pregnancy rates from the adult CHD population . In addition, Quebec provides universal health care to its resident and more than 99% of women in the province are admitted to hospital for delivery .…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, several prior studies on pregnancy outcomes in women with CHD have included women already known to be pregnant, precluding estimation of pregnancy rates from the adult CHD population. 3,4,[8][9][10]23,31 In addition, Quebec provides universal health care to its resident and more than 99% of women in the province are admitted to hospital for delivery. 32,33 Thus, outcomes described were highly representative of the underlying population.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease

Bottega

Malhamé

Guo

et al. 2019

Congenital Heart Disease

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Background The number of women with congenital heart disease (CHD) of reproductive age is increasing, yet a description of trends in pregnancy and delivery outcomes in this population is lacking. Objective To assess secular trends in pregnancy rates, delivery outcomes, and related health care utilization in the adult female CHD population in Quebec, Canada. Methods The Quebec CHD database was used to construct a cohort with all women with CHD aged 18‐45 years between 1992 and 2004. Pregnancy and delivery rates were determined yearly and compared to the general population. Secular trends in pregnancy and delivery rates were assessed with linear regression. The cesarean delivery rate in the CHD population was compared to the general population. Predictors of cesarean section were determined with multivariable logistic regression. Cox regression, adjusted for comorbidities, was used to analyze the impact of cesarean sections on 1‐year health care use following delivery. Results About 14 878 women were included. A total of 10 809 pregnancies were identified in 5641 women, of whom 4551 (80%) and 2528 (45%) experienced at least one delivery and/or abortion, respectively. Absolute yearly numbers and rates of pregnancies and deliveries increased during the study period (P < .05). The increment in cesarean section rates was more pronounced among women with CHD than among the general population. Gestational diabetes (OR 1.50, 95% CI [1.13, 1.99]), gestational hypertension (OR 1.81, 95% CI [1.27, 2.57]), and preeclampsia (OR 1.59, 95% CI [1.11, 2.8]) were independent predictors of cesarean delivery. Cesarean sections were associated with postpartum cardiac‐hospitalization within 1 year following delivery (HR = 2.35, 95% CI [1.05, 5.28]). Conclusions Yearly numbers and rates of pregnancies and deliveries in adult females with CHD rose significantly during the study period. Cesarean sections led to increased health care utilization. Further research is required to determine causes of high cesarean section rates in this patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease

Bottega

Malhamé

Guo

et al. 2019

Congenital Heart Disease

View full text Add to dashboard Cite

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“…We found that the CARPREG I and mWHO risk prediction tools underestimated adverse events in our population, with high rates of cardiac events despite low CARPREG I and mWHO risk scores. Previous attempts to validate the CARPREG I score in other LMICs have demonstrated both over-and underestimation of risk of adverse events, likely due to the unique spectrum of disease specific to LMICs as compared to the North American cohort from which the CARPREG I score was derived [12,14]. Over half of our cases had pulmonary hypertension, a relative contraindication to pregnancy with significant maternal and neonatal risk, which is not captured in the CARPREG I score, and thus could account for underestimate of risk [8,14,17].…”

Section: Risk Predictionmentioning

confidence: 99%

High Burden of Cardiac Disease in Pregnancy at a National Referral Hospital in Western Kenya

Lumsden

Barasa

Park

et al. 2020

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“…found to be predictive of outcome but has yet to be independently validated. 16 Recent studies suggest the modified WHO classification may be superior to the CARPREG I and ZAHARA scores in predicting poor outcomes, highlighting the challenges inherent in applying and validating these risk schemes. 11,12 F I G U R E 1 Distribution of pregnancies according to CARPREG I score (n = 161), ZAHARA score (n = 160), and modified WHO classification (n = 178) F I G U R E 2 Comparison of observed cardiac events during pregnancy to predicted event rate by CARPREG I and ZAHARA scores…”

Section: Ta B L E 1 (Continued)mentioning

confidence: 99%

“…This limits misclassification bias that can otherwise occur when using ICD codes alone to compare exposures and outcomes. This study excluded pregnancies that ended in termination or miscarriage which could have resulted in a bias toward women with less complex disease and fewer medical comorbidities who completed a pregnancy; however, our population still included a high percentage of women with moderate and complex disease.The study spanned a16 year period during which time research on pregnancy outcomes in CHD grew significantly. Outcomes as a result of changes in counseling and practice could have been impacted by newer data which is not captured in our analysis.…”

mentioning

confidence: 99%

Accuracy of risk prediction scores in pregnant women with congenital heart disease

Kim

Goldberg

Awh

et al. 2019

Congenital Heart Disease

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Objective: To assess performance of risk stratification schemes in predicting adverse cardiac outcomes in pregnant women with congenital heart disease (CHD) and to compare these schemes to clinical factors alone.Design: Single-center retrospective study.Setting: Tertiary care academic hospital. Patients: Women ≥18 years with International Classification of Diseases, NinthRevision, Clinical Modification codes indicating CHD who delivered between 1998 and 2014. CARPREG I and ZAHARA risk scores and modified World Health Organization (WHO) criteria were applied to each woman. Outcome Measures:The primary outcome was defined by ≥1 of the following: arrhythmia, heart failure/pulmonary edema, transient ischemic attack, stroke, dissection, myocardial infarction, cardiac arrest, death during gestation and up to 6 months postpartum. Results:Of 178 women, the most common CHD lesions were congenital aortic stenosis (15.2%), ventricular septal defect (13.5%), atrial septal defect (12.9%), and tetralogy of Fallot (12.9%). Thirty-five women (19.7%) sustained 39 cardiac events.Observed vs expected event rates were 9.9% vs 5% (P = .02) for CARPREG I score 0 and 26.1% vs 7.5% (P < .001) for ZAHARA scores 0.51-1.5. ZAHARA outperformed CARPREG I at predicting adverse cardiovascular outcomes (AUC 0.80 vs 0.72, P = .03) but was not significantly better than modified WHO. Clinical predictors of adverse cardiac event were symptoms (P = .002), systemic ventricular dysfunction (P < .001), and subpulmonary ventricular dysfunction (P = .03) with an AUC 0.83 comparable to ZAHARA (P = .66).Conclusions: CARPREG I and ZAHARA scores underestimate cardiac risk for lower risk pregnancies in these women. Of the three risk schemes, CARPREG I performed least well in predictive capacity. Clinical factors specific to the population studied are comparable to stratification schemes. K E Y W O R D Sadult congenital heart disease, outcomes, pregnancy, risk stratification | 471 KIM et al. | INTRODUC TI ONAs survival of those born with congenital heart disease (CHD) shifts toward adulthood, there are a growing number of females with CHD who reach childbearing age. From 1998 to 2007, the proportion of hospitalizations for delivery increased by 34.9% in women with CHD compared to 21.3% in the female general population. 1 Pregnancy outcomes for women with CHD can be highly variable and pose special challenges for congenital cardiovascular specialists and high-risk obstetricians who are tasked with counseling these women and managing them throughout pregnancy, delivery, and postpartum period. Risk stratification schemes predicting adverse outcomes in pregnant women with CHD have been published 2-6 with variable accuracy. 7-12 The objectives of this study were (1) to assess the performance of CARPREG I, ZAHARA, and the modified World Health Organization (WHO) classification in predicting adverse cardiovascular outcomes in women with CHD at a single tertiary care center with an established adult CHD program in an urban North American setting and (2) to compare the...

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Pregnancy Outcomes in Women With Heart Disease

Abstract: Pregnancy in women with heart disease continues to be associated with significant morbidity, although mortality is rare. Prediction of maternal cardiac complications in women with heart disease is enhanced by integration of general, lesion-specific, and delivery of care variables.

Cited by 476 publications

References 29 publications

Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease

Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease

High Burden of Cardiac Disease in Pregnancy at a National Referral Hospital in Western Kenya

Accuracy of risk prediction scores in pregnant women with congenital heart disease

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