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(Circulation. 1997;96:2789-2794.)
© 1997 American Heart Association, Inc.
Articles |
Risk and Predictors for Pregnancy-Related Complications in Women With Heart Disease
From the Division of Cardiology, Department of Medicine (S.C.S., D.A.H., E.G., J.M.C.) and Department of Obstetrics and Gynecology (M.S., G.L., S.S.), The Toronto Hospital; Division of Cardiology (J.M.C.) and Department of Obstetrics and Gynecology (D.F.), Mount Sinai Hospital; Division of Cardiology (J.C.S.) and Department of Obstetrics and Gynecology (K.S.A.), Women's College Hospital; and Division of Pediatric Cardiology (J.F.S.), Hospital for Sick Children, University of Toronto, Toronto, Canada.
Correspondence to Samuel Siu, MD, GW 3-526, 200 Elizabeth St, The Toronto Hospital, Toronto, Ontario, Canada, M5G 2C4. E-mail samuel.siu{at}utoronto.ca
Background The physiological changes of pregnancy can result in cardiovascular complications in the mother, which in turn may have fetal implications. Prior studies have focused on specific cardiac lesions or identified univariate predictors. There is a need to refine the risk stratification of women with heart disease so they can receive appropriate obstetrical counseling and care.
Methods and Results We examined the outcomes of 221 women with heart disease who underwent 276 pregnancies and received their obstetrical care at three Toronto hospitals from 1986 through 1994. Those who underwent therapeutic abortions were excluded. Among the study participants, there were 24 miscarriages and 252 completed pregnancies (pregnancies not ending in miscarriage). Maternal heart failure, arrhythmia, or stroke occurred in 45 completed pregnancies (18%). There were no maternal deaths. Poor maternal functional class or cyanosis, myocardial dysfunction, left heart obstruction, prior arrhythmia, and prior cardiac events were predictive of maternal cardiac complications. These predictors were incorporated into a point score that can be used to estimate the probability of a cardiac complication in the mother. The rate of cardiac complications for a patient with 0, 1, and >1 of the above factors was 3%, 30%, and 66%, respectively. Neonatal complications occurred in 42 completed pregnancies (17%). Neonatal events included death (2), respiratory distress syndrome (16), intraventricular hemorrhage (2), premature birth (35), and small-for-gestational-age birth weight (14). Poor maternal functional class or cyanosis was predictive of neonatal events.
Conclusions Despite low maternal and neonatal mortality, pregnancy in women with heart disease is associated with significant cardiac and neonatal morbidity. The probability of maternal cardiac or neonatal events can be predicted from baseline characteristics of the mother.
Key Words: epidemiology • heart defects, congenital • prognosis
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