doi: 10.1161/hc3001.093437
(Circulation. 2001;104:515.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Prospective Multicenter Study of Pregnancy Outcomes in Women With Heart Disease
From the University of Toronto (S.C.S., M.S., J.M.C., J.F.S., K.S.A., D.F., J.C.S., S.S.), Toronto, Ontario; University of Calgary (A.N.A.), Calgary, Alberta; University of Montreal (L.-A.M.), Montreal, Quebec; University of Ottawa (B.C.M.), Ottawa, Ontario; Dalhousie University (C.M.K.), Halifax, Nova Scotia; University of Western Ontario (M.L.B.), London, Ontario; University of British Columbia (M.C.K.), Vancouver, British Columbia; McGill University (F.M.), Montreal, Quebec; University of Alberta (D.A.T.), Edmonton, Alberta; McMaster University (E.P.G.), Hamilton, Ontario; and University of Manitoba (J.W.T.), Winnipeg, Manitoba, Canada.
Correspondence to Samuel Siu, MD, Toronto General Hospital, PMCC3-526,200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4. E-mail Sam.Siu{at}uhn.on.ca
Background— The maternal and neonatal risks associated with pregnancy in women with heart disease receiving comprehensive prenatal care have not been well defined.
Methods and Results— We prospectively enrolled 562 consecutive pregnant women with heart disease and determined the outcomes of 599 pregnancies not ending in miscarriage. Pulmonary edema, arrhythmia, stroke, or cardiac death complicated 13% of pregnancies. Prior cardiac events or arrhythmia, poor functional class or cyanosis, left heart obstruction, and left ventricular systolic dysfunction independently predicted maternal cardiac complications; the cardiac event rate can be predicted using a risk index incorporating these predictors. Neonatal complications (20% of pregnancies) were associated with poor functional class or cyanosis, left heart obstruction, anticoagulation, smoking, and multiple gestations.
Conclusions— Pregnancy in women with heart disease is associated with significant cardiac and neonatal complications, despite state-of-the-art obstetric and cardiac care. Maternal cardiac risk can be predicted with the use of a risk index.
Key Words: pregnancy • heart diseases • prognosis
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