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. 2018 Nov 6;7(21):e009395.
doi: 10.1161/JAHA.118.009395.

Neonatal and Maternal Outcomes in Pregnant Women With Cardiac Disease

Amanda Owens  1 , Jie Yang  2   3 , Lizhou Nie  3 , Fabio Lima  4 , Cecilia Avila  5 , Kathleen Stergiopoulos  1
Affiliations

Neonatal and Maternal Outcomes in Pregnant Women With Cardiac Disease

Amanda Owens et al. J Am Heart Assoc. .

Abstract

Background Pregnant women with underlying heart disease ( HD ) are at increased risk for adverse maternal, obstetric, and neonatal outcomes. Methods and Results Inpatient maternal delivery admissions and linked neonatal stays for women with cardiomyopathy, adult congenital HD, pulmonary hypertension ( PH ), and valvular HD were explored utilizing the Statewide Planning and Research Cooperative System (New York), January 1, 2000, through December 31, 2014, with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Maternal major adverse cardiac events, neonatal adverse clinical events ( NACE ), and obstetric complications were recorded. Outcomes were compared using multiple logistic regression modeling. Among 2 284 044 delivery admissions, 3871 women had HD ; 676 (17%) had cardiomyopathy, 1528 (40%) had valvular HD, 1367 (35%) had adult congenital HD, and 300 (8%) had PH . Major adverse cardiac events occurred in 16.1% of women with HD , with most in the cardiomyopathy (45.9%) and PH (25%) groups. NACE was more common in offspring of women with HD (18.4% versus 7.1%), with most in the cardiomyopathy (30.0%) and PH (25.0%) groups. Increased risk of NACE was noted for women with HD (odds ratio [ OR ]: 2.8; 95% confidence interval [ CI ], 2.5-3.0), with the highest risk for those with cardiomyopathy ( OR : 5.9; 95% CI , 5.0-7.0) and PH ( OR : 4.5; 95% CI , 3.4-5.9). Preeclampsia ( OR : 5.1; 95% CI , 3.0-8.6), major adverse cardiac events ( OR : 2.3; 95% CI , 1.8-2.9), preexisting diabetes mellitus ( OR : 4.3; 95% CI , 1.5-12.3), and obstetric complications ( OR : 2.9; 95% CI , 1.7-5.2) were independently associated with higher NACE risk. Conclusions Neonatal complications were higher in offspring of pregnant women with HD , particularly cardiomyopathy and PH . Preeclampsia, major adverse cardiac events, obstetric complications, and preexisting diabetes mellitus were independently associated with a higher risk of NACE .

Keywords: adult congenital heart disease; cardiomyopathy; pregnancy; pulmonary hypertension; valve.

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Figures

Figure 1
Figure 1
Study population creation. Inclusion and exclusion of study records utilized from the Statewide Planning And Research Cooperative System (SPARCS).
Figure 2
Figure 2
Prevalence of pregnancy and heart disease of various etiologies in New York State, 2000–2014.
Figure 3
Figure 3
Maternal and neonatal adverse events. A, MACE in pregnant women with HD and by HD subtype. B, NACE in offspring of pregnant women with HD and by HD subtype. C, Neonatal complications in offspring of women with HD. ACHD indicates adult congenital heart disease; CM, cardiomyopathy; HD, heart disease; MACE, major adverse cardiac event; NACE, neonatal adverse clinical events; PH, pulmonary hypertension; VHD, valvular heart disease.
See this image and copyright information in PMC

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