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Overview :
Siu et al identified risk factors for adverse outcomes in
pregnant women with heart disease. This can help identify a woman and neonate at
risk for complications, which can aid in prevention and early intervention. The
authors were investigators for the Cardiac Disease in Pregnancy (CARPREG) study
from multiple institutions in Canada.
Study population: 562 consecutive pregnant women with heart
disease having 599 pregnancies not ending in miscarriage:
• All received comprehensive prenatal care.
• 13% of
pregnancies had maternal complications (pulmonary edema, cardiac arrhythmia,
stroke, cardiac death)
• 20% of
pregnancies had neonatal complications
Outcomes:
(1) cardiac complications in mother
(2) neonatal complications
(3) pregnancy-induced hypertension (PIH)
(4) postpartum hemorrhage
|
Outcome |
Risk
Factor |
Odds Ratio |
95% CI |
|
cardiac |
history of cardiac event or arrhythmia |
6 |
3 -
14 |
|
|
NYHA functional class > II (III or IV) OR
cyanosis |
6 |
2 - 22 |
|
|
left heart obstruction |
6 |
3 -
14 |
|
|
systemic ventricular dysfunction |
11 |
4 -
34 |
|
neonatal |
NYHA functional class > II (III or IV) OR
cyanosis |
3 |
1.1 –
6.1 |
|
|
heparin or warfarin during pregnancy |
3 |
1.4 –
8.2 |
|
|
smoking |
2 |
1.3 –
3.9 |
|
|
multiple gestations |
22 |
6 –
85 |
|
|
left heart obstruction |
2 |
1.01 –
2.9 |
|
PIH |
nulliparity |
5 |
2 –
17 |
|
|
systemic lupus erythematosus |
24 |
5 –
108 |
|
|
coarctation of the aorta |
3 |
2 –
10 |
|
postpartum hemorrhage |
peripartum heparin or warfarin |
7 |
2 –
22 |
|
|
cyanosis |
27 |
4 -
177 |
where:
• NYHA =
New York Heart Association (see Cardiac chapter)
• prior
cardiac events: heart failure, transient ischemic attack, or stroke before
pregnancy
• left
heart obstruction, one or more of the following: (a) mitral valve area < 2
square cm; (b) aortic valve area < 1.5 square cm; (c) peak left ventricular
outflow tract gradient > 30 mm Hg by echocardiography
• systemic
ventricular dysfunction: ejection fraction < 40%
risk index for cardiac disease =
= SUM(risk factors present)
Interpretation:
• minimum risk index: 0
• maximum risk index: 4
• Of the women who died (3, or 0.53%) all had 1 or more risk
factors.
|
Risk Index |
Risk Cardiac
Complication |
|
0 |
5% |
|
1 |
27% |
|
2 - 4 |
75% |
|