The impact of cardiovascular diseases on maternal deaths in the Nordic countries

Nyfløt, Lill Trine; Johansen, Marianne; Mulic‐Lutvica, Ajlana; Gissler, Mika; Bødker, Birgit; Bremme, Katarina; Ellingsen, Liv; Vangen, Siri

doi:10.1111/aogs.14104

Cited by 12 publications

(10 citation statements)

References 27 publications

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“…6,7 Strategies for diagnosis and management and opportunities for improvement in various aspects of care clearly differ according to whether a condition is already known before the acute event, yet case series of maternal deaths have rarely made this distinction. [6][7][8] Further separation of cardiac and vascular diseases is also needed because pathophysiologic pathways leading to maternal deaths differ between those two entities. In particular, vascular diseases responsible for maternal deaths, including aortic rupture or splenic or renal arterial rupture, have rarely been described, although they may have their own preventability factors.…”

Section: Methodsmentioning

confidence: 99%

Timing and Preventability of Cardiovascular-Related Maternal Death

Diguisto

Choinier

Saucedo

et al. 2023

Obstetrics &Amp; Gynecology

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Section: Methodsmentioning

confidence: 99%

Timing and Preventability of Cardiovascular-Related Maternal Death

Diguisto

Choinier

Saucedo

et al. 2023

Obstetrics &Amp; Gynecology

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“…Heart disease is an important indirect cause of maternal death and morbidity in high‐income countries and complicates 0.2%–4.0% of pregnancies 1–4 . In women with heart disease, the physiologic cardiovascular adaptations to pregnancy can be a challenge, both to the mother and the fetus.…”

Section: Introductionmentioning

confidence: 99%

“…Heart disease is an important indirect cause of maternal death and morbidity in high‐income countries and complicates 0.2%–4.0% of pregnancies. 1 , 2 , 3 , 4 In women with heart disease, the physiologic cardiovascular adaptations to pregnancy can be a challenge, both to the mother and the fetus. In normal pregnancy, maternal cardiac output and heart rate rise and peripheral resistance decreases partially due to the formation of a low‐resistance circuit in the uteroplacental circulation.…”

Section: Introductionmentioning

confidence: 99%

Maternal beta‐blocker dose and risk of small‐for gestational‐age in women with heart disease

Sørbye

Haualand

Wiull

et al. 2022

Acta Obstet Gynecol Scand

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Introduction: Beta-blockers are prescribed for many pregnant women with heart disease, but whether there is a dose-dependent effect on fetal growth remains to be examined. We aimed to investigate if antenatal beta-blocker use and dose were associated with delivering a small-for-gestational-age infant among women with heart disease.Material and methods: Our cohort included women with heart disease who delivered at Oslo University Hospital between 2006 and 2015. Maternal heart disease was classified into modified WHO risk scores. Women with beta-blocker treatment were dichotomized into whether they had been treated with a low or high dose based on clinical factors. We compared the risk of delivering a small-for-gestational-age infant in women exposed to high doses, low doses, or with no exposure to antenatal betablockers while adjusting for severity of maternal heart disease in logistic regression models.Results: Of a total of 540 pregnancies among women with heart disease, 163 (30.2%) were exposed to beta-blocker treatment. The majority were treated with metoprolol (86.5%). Almost twice as many babies in the beta-blocker group were small-forgestational-age, compared with the non-exposed group (19.8 vs 9.5%, P < 0.001).Women using a high-dose beta-blocker had a five-fold increased risk of delivering a small-for-gestational-age infant compared with non-exposure (adjusted odds ratio [aOR] 4.89, 95% confidence interval [CI] 2.22-10.78, P < 0.001). Women using a low dose of beta-blocker had a two-fold increased risk of delivering a small-forgestational-age infant; however, the confidence interval included the null (aOR 1.75, 95% CI 0.83-3.72, P = 0.143). Results when restricting the analyses to metoprolol showed the same pattern, but with attenuation of risks. Conclusions:We found a five-fold increased risk of delivering a small-for-gestationalage infant in women with heart disease treated with a high dose of beta-blocker, and a two-fold increased risk among those treated with a low dose, showing an apparent | 795 SØRBYE Et al.

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“…Maternal heart disease (HD) is the leading cause of indirect maternal death in several high-income countries, including Italy. It is also associated with substantial maternal and feto-neonatal morbidity 1–4…”

Section: Introductionmentioning

confidence: 99%

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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The impact of cardiovascular diseases on maternal deaths in the Nordic countries

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 12 publications

References 27 publications

Timing and Preventability of Cardiovascular-Related Maternal Death

Timing and Preventability of Cardiovascular-Related Maternal Death

Maternal beta‐blocker dose and risk of small‐for gestational‐age in women with heart disease

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

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