Pregnancy outcomes in women with heart disease: the Madras Medical College Pregnancy And Cardiac (M-PAC) Registry from India

Gnanaraj, Justin Paul; Princy, S Anne; Anju, Surendran S.; Anita, Susikar; Mary, Majella Cecily; Gnanavelu, G; Kanmani, K; Meena, Mahalingam; Mohanan, Nandakumaran; Ramya, Swaminathan; Ravishankar, G.; Shaanthi, Gunasingh; Shoba, Somasundaram; Sangareddi, Venkatesan; Vijaya, Subramanian; Gomathy,; Geetha,; Rani, Usha; Selvi, N Tamil; Sarala,; Selvi, B Tamil; Elizabeth, Prema; Nalina,; Priyadarsene,; Kasthuri,; Sadhana,; Sindhumathy,; Sudarshini,; Nazreeen,; Shanmugasundaram, Devika; Sivakumar, Shoba; Umarani, C; Priya, R; Kaleeswari,; Suganya,; Shunmugam, Ravi Marimuthu; Ganapathy, Palaniswamy; Chandran, Moorthy; Nagarajan, Swaminathan; Manohar, G.; Angappamudali, Arumugam Moongilpatti; Jeyabalan, Nambirajan; Palani, Balaji Pandian; Saravanababu,; Srinivasan, Kumaran; Elangovan, Elavarasi Manimegalai; Mohandoss, Nageswaran Piskala; Chandrasekaran, Ezhilarasi; Duraipandian, Rajasekar Ramesh; Gorijavaram, Pratap Kumar; Kunjjitham, Tamilselvan; Ravindran, Binoy; Dharmarajan,; Kaliyamurthy, Thiagarajan; Sreeram, Jeyalaxmi; Seeralan, Arasar; Mangalabharathi,; Baliah, Mariappan; Manimaran, Chandrika; kumar, Ebenezer Joel

doi:10.1093/eurheartj/ehad003

Cited by 12 publications

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“…According to research by Gnanaraj Justin Paul et al . (1.6%),[ 16 ] all pregnancy-related deaths were caused by heart-related diseases. As a result of our center's interdisciplinary approach and close monitoring of high-risk patients, fewer women are reportedly passing away from cardiac causes.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular disease in pregnancy and its outcome: A prospective study

Prasad,

Choudhary

et al. 2023

Journal of Family Medicine and Primary Care

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Introduction: Prevalence estimates place maternal heart illness anywhere from 0.3 to 3.5 percent. Up to 20.5% of all maternal deaths of non-obstetrical cause are attributable to cardiovascular disease. Aim: The aim of the study was the management of patients with the multidisciplinary approach to maternal cardiovascular disease and its influence on maternal and fetal outcomes in a tertiary care centre. Objectives: 1. To find out the prevalence and spectrum of heart disease in Pregnancy. 2. To find out the outcome of pregnancy with heart disease in a tertiary care centre. Materials and Methods: This prospective study of one year was done on pregnant with heart disease coming to the Obstetrics and Gynaecology department in collaboration with the cardiology department of IGIMS, Patna. A study was done on 65 pregnant with heart disease between the age group 20 to 35 years were compared to a control group of 65 pregnant women who were hospitalised during the same time period but did not have heart disease. All the pregnant women with heart disease were included in this study. Patients with medical disorders like Kidney disease, Liver disease, Pulmonary Disease, Diabetes Mellitus were excluded from the study. We used IBM's SPSS v23 to analyse the collected data. Result: Prevalence of heart disease in pregnancy was 5.8% in present study and mostly of RHD (62.5%), followed by corrected CHD (12.5%) and CHD (10.9%). Patients of NYHA Class I and II (58.5%), Class III (26.2%), and Class IV (15.4%). The mitral valve was most often impacted by RHD (35.3% of all cases), followed by the tricuspid valve (15.0%). Eight (1.1%) people had cardiac surgery for therapeutic reasons. Six percent of all corrective surgeries included closing an atrial septal defect (ASD). The most common kind of congenital abnormality was a ventricular septal defect (VSD, 3%), followed by atrial septal defect (ASD, 1.5%) and pulmonary ductal atresia (PDA, 1.5%). Patients with heart disease had a higher rate of MTP, emergency LSCS and instrumental births than the controls. Deaths during pregnancy were 4 (6.2%) with cardiac disease and no maternal mortality in control group and all belonged to NYHA Class 4 were anaemic. In patients with a left ventricular ejection fraction of 45% or below, death was high. Two women died intrapartum from RHD, and two died postpartum from Peripartum cardiomyopathy. There were significantly more incidences of low-birth-weight infants (36.4%) compared to the control group (p = 0.001). Cases had a statistically significant greater frequency of obstetric problems, as well as an increased risk of developing anaemia, hypertension, hypothyroidism, cholestasis, FGR, and GDM (p-value 0.017). Multiparity, severe valvular lesion, NYHA function class III or IV, arrhythmia, and low ejection fraction were associated with poor maternal outcome in the current study. Conclusion: Maternal morbidity and mortality due to heart disease can be reduced appreciably by antenatal care, early diagnosis, and management with the help of cardiologists and surgery in selected cases.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular disease in pregnancy and its outcome: A prospective study

Prasad,

Choudhary

et al. 2023

Journal of Family Medicine and Primary Care

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“…Valvular heart disease particularly rheumatic heart disease is the commonest cause of heart disease in pregnancy in India unlike the developed nations, where congenital HD predominates. 2 , 17 Studies from India have also shown that heart failure is the most common adverse cardiac event during pregnancy and puerperium, similar to rest of the world. 2 , 18 We have recently published the M-PAC registry 2 , the largest single-center study on pregnant women with heart disease (PWWHD) globally, which included 1005 women with 1029 pregnancies.…”

Section: Indian Data Of Pwwhdmentioning

confidence: 98%

“… 2 , 17 Studies from India have also shown that heart failure is the most common adverse cardiac event during pregnancy and puerperium, similar to rest of the world. 2 , 18 We have recently published the M-PAC registry 2 , the largest single-center study on pregnant women with heart disease (PWWHD) globally, which included 1005 women with 1029 pregnancies. Remarkably, 60% of these women received their first-ever heart disease diagnosis during pregnancy.…”

Section: Indian Data Of Pwwhdmentioning

confidence: 98%

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Bridging gaps: The urgent call for cardio-obstetrics as a subspecialty in India

Gnanaraj,

Anne Princy

2024

Indian Heart Journal

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“…Characterized with long and hot summers, Fuzhou has a humid subtropical climate, with a population of around 8 million in 2020. The inclusion criteria were hCG or/and ultrasound-confirmed clinical pregnancy, maternal age between 18-50 years, without the following diseases which were found to be associated with APOs: hyperthyroidism (16), heart disease (17), chronic kidney disease (18), tuberculosis (19), and psychiatric disease (20). Those who did not live in Fuzhou city during pregnancy and gestational age ≥ 42 weeks were excluded from this study.…”

Section: Participant Recruitmentmentioning

confidence: 99%

Impact of ambient temperature on adverse pregnancy outcomes: a birth cohort study in Fuzhou, China

Lin,

Yang,

Nuermaimaiti

et al. 2023

Front. Public Health

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BackgroundPrevious studies have identified a series of specific adverse pregnancy outcomes (APOs) linked with temperature extremes. Most of them focus on preterm birth, low birth weight, and stillbirth. Other possible adverse outcomes were under-researched. This study aimed to investigate the impact of ambient temperature on maternal complications, white blood cell count (WBC), newborn hearing, and neonatal jaundice.MethodsA total of 418 participants were recruited from Fuzhou Maternity & Child Healthcare Hospital in 2016. Participants were invited to fill out a structured questionnaire. The gridded near-surface air temperatures at a resolution of 0.1°* 0.1° for Fuzhou were extracted from a published dataset. Meteorological data and PM2.5 were extracted based on participants’ residential addresses using R packages “ncdf4” and “raster.” Multivariate logistic regression models were used to quantify the effects of ambient temperature on APOs after controlling for confounders.ResultsOverall, there were 107 APOs, accounting for 25.6% of all participants. Every 1°C increase in mean temperature was associated with a 10.0% increase in APOs (aOR = 1.100, 95%CI 1.006–1.203) during the period of early pregnancy. However, negative associations were observed in the middle pregnancy period, and a 1°C increase in mean temperature was associated 8.8% decrease in APOs (aOR = 0.912, 95%CI 0.846–0.982). Diurnal temperature variation had a significant impact on APOs in the third trimester. Infant jaundice was negatively associated with temperature exposure in the middle and late pregnancy periods. The risk of neonatal jaundice increased at lag weeks 2–9 in the first trimester, with the greatest lagged effect (aOR = 1.201, 95%CI 1.020–1.413) observed at lag week 3. A 1°C increase in mean temperature led to a 29.6% (aOR = 1.296, 95%CI 1.019–1.649) increase in high WBC. A 1°C increase in temperature variation was associated with more than two times (aOR = 2.469, 95%CI 1.001–6.089) increase of high WBC in the first trimester and about five times (aOR = 4.724, 95%CI 1.548–14.409) increase in the third trimester.ConclusionAmbient temperature affects neonatal jaundice, newborn hearing loss, and infections during pregnancy. In addition to the identified epidemiologic link and susceptible exposure windows, there is a need to understand the underlying biological mechanisms for better recommendations for climate change adaptation policies.

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Pregnancy outcomes in women with heart disease: the Madras Medical College Pregnancy And Cardiac (M-PAC) Registry from India

Cited by 12 publications

References 0 publications

Cardiovascular disease in pregnancy and its outcome: A prospective study

Cardiovascular disease in pregnancy and its outcome: A prospective study

Bridging gaps: The urgent call for cardio-obstetrics as a subspecialty in India

Impact of ambient temperature on adverse pregnancy outcomes: a birth cohort study in Fuzhou, China

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