Original Investigation
Pregnancy Outcomes in Women With Heart Disease: The CARPREG II Study

https://doi.org/10.1016/j.jacc.2018.02.076Get rights and content
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Abstract

Background

Identifying women at high risk is an important aspect of care for women with heart disease.

Objectives

This study sought to: 1) examine cardiac complications during pregnancy and their temporal trends; and 2) derive a risk stratification index.

Methods

We prospectively enrolled consecutive pregnant women with heart disease and determined their cardiac outcomes during pregnancy. Temporal trends in complications were examined. A multivariate analysis was performed to identify predictors of cardiac complications and these were incorporated into a new risk index.

Results

In total, 1,938 pregnancies were included. Cardiac complications occurred in 16% of pregnancies and were primarily related to arrhythmias and heart failure. Although the overall rates of cardiac complications during pregnancy did not change over the years, the frequency of pulmonary edema decreased (8% from 1994 to 2001 vs. 4% from 2001 to 2014; p value = 0.012). Ten predictors of maternal cardiac complications were identified: 5 general predictors (prior cardiac events or arrhythmias, poor functional class or cyanosis, high-risk valve disease/left ventricular outflow tract obstruction, systemic ventricular dysfunction, no prior cardiac interventions); 4 lesion-specific predictors (mechanical valves, high-risk aortopathies, pulmonary hypertension, coronary artery disease); and 1 delivery of care predictor (late pregnancy assessment). These 10 predictors were incorporated into a new risk index (CARPREG II [Cardiac Disease in Pregnancy Study]).

Conclusions

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.

Key Words

arrhythmia
cardiology
cardiomyopathy
congenital heart disease
heart failure
mortality
outcomes
pregnancy
risk score
valve disease

Abbreviations and Acronyms

CI
confidence interval
HF
heart failure
LVOT
left ventricular outflow tract
mWHO
modified World Health Organization
NYHA
New York Heart Association
WHO
World Health Organization

Cited by (0)

This study was supported in part by operating grants provided by the Heart and Stroke Foundation of Canada (NA 5662), Canadian Institutes of Health Research (MOP 111139 and 119353), and the Canadian Foundation for Innovation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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