Abstract 16568: Investigation of Adverse Outcomes in Pregnant Women With Pulmonary Hypertension at the Time of Delivery
Introduction: Pregnant women with heart disease often have major adverse cardiac events (MACE) during delivery. Pulmonary hypertension (PH) has been widely presumed to be a strong contraindication to pregnancy.
Hypothesis: There is limited data on the impact of PH on pregnancy outcomes and the risk of adverse cardiac events.
Methods: National Inpatient Sample was screened for hospital admissions of women delivering between years 2003-2012. The primary outcome was MACE, a composite of death, cardiac arrest, cardiogenic shock, myocardial infarction, respiratory failure, arrhythmia, stroke, and embolic event.
Results: Data on 1519 patients with PH and 6,757,582 without heart disease or PH was available for study. Patients with PH included: 59.6% with isolated PH; 10.7% with PH and congenital heart disease (PH+CHD); 18.1% with PH and valvular heart disease (PH+VHD); 3% with PH, VHD and CHD (PH+VHD+CHD); 6.6% PH and cardiomyopathy (PH+CDM); and 1.9% with PH+CDM+VHD. Compared to women without heart disease or PH, women with PH experienced significantly higher MACE (24.8 vs 0.4%, OR=88.1). Among the subsets of women with PH, the highest MACE were noted in women with the combination of PH+CDM+VHD, and those with PH+CDM, primarily due to heart failure and arrhythmia (Figure 1). Women with PH+CDM or PH+CDM+VHD were significantly more likely to experience eclampsia (p=0.009), preterm delivery (p=0.015), multiple gestation (p=0.024), and intrauterine fetal demise (p=0.0471). PH subtype is significantly associated with MACE in multivariable analysis (p < 0.001).
Conclusions: In a contemporary dataset of pregnant women at the time of delivery, the presence of PH was associated with an increase in MACE, with an exceptionally elevated risk among women within the PH+CDM and PH+CDM+VHD subtypes.
Author Disclosures: E. Thomas: None. F.V. Lima: None. J. Xu: None. J. Yang: None. K. Stergiopoulos: None.
- © 2016 by American Heart Association, Inc.