Published Online
on April 15, 2002

A more recent version of this article appeared on May 7, 2002

This Article Full Text (PDF) All Versions of this Article: 105/18/2179    most recent 01.CIR.0000015699.48605.08v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Siu, S. C. Articles by Sermer, M. Search for Related Content PubMed Articles by Siu, S. C. Articles by Sermer, M. Related Collections Pediatric and congenital heart disease, including cardiovascular surgery Epidemiology

Submitted on January 10, 2002
Revised on February 27, 2002
Accepted on February 28, 2002

Adverse Neonatal and Cardiac Outcomes Are More Common in Pregnant Women With Cardiac Disease

Samuel C. Siu MD, SM^*, Jack M. Colman MD, Sheryll Sorensen RN, Jeffrey F. Smallhorn MD, Dan Farine MD, Kofi S. Amankwah MD, John C. Spears MD, and Mathew Sermer MD

From the Department of Medicine, Division of Cardiology (S.C.S., J.M.C., J.C.S.), Department of Obstetrics and Gynecology (S.S., D.F., K.S.A., M.S.), and Department of Pediatrics, Division of Cardiology (J.F.S.), University of Toronto, Toronto, Ontario, Canada.

^* To whom correspondence should be addressed. E-mail: Sam.Siu{at}uhn.on.ca.

Background—Pregnant women with heart disease (HD) are at increased risk for cardiac (CV) complications. However, the frequency of neonatal (NE) complications in pregnant women with HD relative to pregnant women without HD has not been examined.

Methods and Results—Pregnant women with HD were prospectively monitored during 302 pregnancies. The frequency of NE and CV complications was compared with those in a control group without HD during 572 pregnancies. The frequency of NE complications was higher in the HD group (18% versus 7%; HD versus controls). The NE complication rate was lowest in pregnancies of women age 20 to 35 years who did not smoke during pregnancy, did not receive anticoagulants, and had no obstetric risk factors: 4% in control patients, 5% in HD patients with no cardiac risk factors for NE complications (left heart obstruction, poor functional class, or cyanosis), and 7% in HD patients with 1 such risk factor. In contrast, the event rate in pregnancies of controls age <20 or >35 years who had obstetric risk factors or multiple gestation or who smoked was 11%. In the HD group, women age <20 or >35 years who had obstetric risk factors or multiple gestation, who smoked, or who received anticoagulants experienced an even higher NE complication rate (27% with no cardiac risks for NE events and 33% in the presence of 1 cardiac risk factors). The frequency of CV complications was higher in the HD group (17% versus 0%; HD versus controls).

Conclusion—Pregnant women with HD are at increased risk for both NE and CV complications. The risk for NE adverse events in pregnant women with HD is highest in those with both obstetric and cardiac risk factors for NE complications.

Key words: pregnancy • heart disease • prognosis

This article has been cited by other articles:

				S. Tsiaras and A. Poppas Mitral valve disease in pregnancy: outcomes and management Obstet Med, March 1, 2009; 2(1): 6 - 10. [Abstract] [Full Text] [PDF]

				S. Chandrasekhar, C. R. Cook, and C. D. Collard Cardiac Surgery in the Parturient Anesth. Analg., March 1, 2009; 108(3): 777 - 785. [Abstract] [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): e143 - e263. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 2, 2008; 52(23): 1890 - 1947. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): e714 - e833. [Full Text] [PDF]

				C. A. Warnes, R. G. Williams, T. M. Bashore, J. S. Child, H. M. Connolly, J. A. Dearani, P. del Nido, J. W. Fasules, T. P. Graham Jr, Z. M. Hijazi, et al. ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, December 2, 2008; 118(23): 2395 - 2451. [Full Text] [PDF]

				2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142. [Full Text] [PDF]

				V. Stangl, J. Schad, G. Gossing, A. Borges, G. Baumann, and K. Stangl Maternal heart disease and pregnancy outcome: A single-centre experience Eur J Heart Fail, September 1, 2008; 10(9): 855 - 860. [Abstract] [Full Text] [PDF]

				E. Bedard, D. F. Shore, and M. A. Gatzoulis Adult congenital heart disease: a 2008 overview Br. Med. Bull., March 1, 2008; 85(1): 151 - 180. [Abstract] [Full Text] [PDF]

				M. Thangaroopan, R. M. Wald, C. K. Silversides, J. Mason, J. F. Smallhorn, M. Sermer, J. M. Colman, and S. C. Siu Incremental Diagnostic Yield of Pediatric Cardiac Assessment After Fetal Echocardiography in the Offspring of Women With Congenital Heart Disease: A Prospective Study Pediatrics, March 1, 2008; 121(3): e660 - e665. [Abstract] [Full Text] [PDF]

				K. K Stout and C. M Otto Pregnancy in women with valvular heart disease Heart, May 1, 2007; 93(5): 552 - 558. [Abstract] [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]

				A. Uebing, P. J Steer, S. M Yentis, and M. A Gatzoulis Pregnancy and congenital heart disease BMJ, February 18, 2006; 332(7538): 401 - 406. [Full Text] [PDF]

				U. Elkayam, M. W. Akhter, H. Singh, S. Khan, F. Bitar, A. Hameed, and A. Shotan Pregnancy-Associated Cardiomyopathy: Clinical Characteristics and a Comparison Between Early and Late Presentation Circulation, April 26, 2005; 111(16): 2050 - 2055. [Abstract] [Full Text] [PDF]

				G. R. Veldtman, H. M. Connolly, M. Grogan, N. M. Ammash, and C. A. Warnes Outcomes of pregnancy in women with tetralogy of fallot J. Am. Coll. Cardiol., July 7, 2004; 44(1): 174 - 180. [Abstract] [Full Text] [PDF]

				J. S. Child Fallot's tetralogy and pregnancy: Prognostication and prophesy J. Am. Coll. Cardiol., July 7, 2004; 44(1): 181 - 183. [Full Text] [PDF]

				J. Arafeh and Y. Y. El-Sayed Cardiac Disease in Pregnancy NeoReviews, June 1, 2004; 5(6): e232 - e239. [Full Text] [PDF]

				R. F. Redberg and N. B. Schiller Gender and valvular surgery J. Thorac. Cardiovasc. Surg., January 1, 2004; 127(1): 1 - 3. [Full Text] [PDF]

				S. C. Reimold and J. D. Rutherford Valvular Heart Disease in Pregnancy N. Engl. J. Med., July 3, 2003; 349(1): 52 - 59. [Full Text] [PDF]