Heart Disease in Pregnant Women Raises Risk of Maternal, Neonatal Complications

Women with heart disease during their first pregnancy had a higher rate of maternal cardiac events and neonatal complications, especially if they also had pulmonary hypertension (PH), according to study findings published in BMC Pregnancy and Childbirth. The study also identified factors that can predict which pregnant women with heart disease will develop heart failure.

Using a large medical record database of more than 45,000 women in their first pregnancy treated at 7 medical centers in Southwestern China, researchers identified those with and without heart disease, and further classified the women with heart disease into groups with valvular heart disease, adult congenital heart disease, cardiomyopathy, PH, and other cardiac diseases.

The women with heart disease (n = 508) had higher rates of arrythmia (14.6% vs 0.1%) and heart failure (14.4% vs 0.05%) than those without, leading to a higher rate of major adverse cardiac events (28.0% vs 0.4%) (all P < .0001). They also had a significantly higher rate of obstetric complications (54.8% vs 4.7%; P = .002), although there was a lower incidence of laceration in the group with heart disease, likely because these women were more likely to deliver via cesarean section.

Neonatal adverse clinical events, which included fetal or neonate death, prematurity, and respiratory distress syndrome, were more common among the infants of women with heart disease than of those without (23.3% vs 11.3%; P < .0001). The infants of women with heart disease were more likely to be born premature (12.7% vs 7.1%; P < .0001), contributing to the significant difference in rates of infants with low birth weight (2.0% vs 0.6%; P = 0.015).

In addition to these differences in maternal cardiac outcomes and the neonatal complications, researchers also identified that women with heart disease had higher mean total hospital costs (¥9581 vs ¥5212 [US $1368 vs US $744]; P < .0001) and rates of acute renal failure (1.0% vs 0.0%; P < .0001).

The study authors noted that PH was associated with higher rates of adverse maternal cardiac events, specifically heart failure, and neonatal prematurity. Women with PH were more likely to develop incident heart failure (42.9%) than those with other types of heart disease (4.9%-25.8%; P < .0001).

Multivariable models revealed that significant independent predictors of heart failure were New York Heart Association functional class of 3 or greater, heart rate of 100 beats per minute or greater, ejection fraction of 60% or less, and left ventricular end-diastolic diameter of 50 mm or greater.

The authors wrote that their findings could inform efforts to more closely monitor women with heart disease during their first pregnancy and ensure that they are aware of the potential risks of maternal and neonatal complications.

“Given the higher rate of these in-hospital complications and predictors of having [heart failure], women with cardiac disease should undergo evaluation of their disease subtype and cardiac function earlier and should be treated in centers with expertise on a multidisciplinary approach,” they concluded.

Reference

Wang W, Wang L, Feng P, et al. Real-world in-hospital outcomes and potential predictors of heart failure in primigravid women with heart disease in Southwestern China. BMC Pregnancy Childbirth. 2020;20:372. doi:10.1186/s12884-020-03058-9