Author + information
- Samuel C.B. Siua,b,
- Mathew Sermera,b,
- Jennifer Masona,b,
- Rachel Walda,b,
- Jack Colmana,b and
- Candice Silversidesa,b
Background: Pregnant women with heart disease are at increased risk of complications. At our centre, management algorithms for this population have been implemented since 2001. However, the impact of standardized care on outcomes has not been evaluated.
Methods: We prospectively recorded baseline and outcomes data on consecutive pregnant women with heart disease referred to our centre from 1994 to 2014. We compared the frequency of complications in women followed during 2 time periods: 1994-2001 and 2001-2014. Risk of cardiac complications was assessed using the validated Canadian Pregnancy and Heart Disease Study (CARPREG) and the modified World Health Organization (WHO) risk classifications. Cardiac (maternal death, heart failure, arrhythmia, or stroke) and perinatal (small-for-gestational-age birth weight or premature birth) complications were recorded.
Results: The study group comprised of 1434 pregnancies in women with heart disease; 65% of pregnancies were in women with congenital heart disease. There was no significant baseline differences between women that underwent pregnancy prior to 2001 (n=415) and those that underwent pregnancy after 2001 (n=1019), with respect to maternal age, prior history of cardiac events, or underlying cardiac diagnosis. The proportion of women in the highest CARPREG/WHO risk group was higher pre 2001 compared to post 2001 (24% vs. 19%; p=0.041). Maternal mortality was rare (0.3%) and, along with perinatal mortality (2%), remained unchanged during the entire 20 year period. While there was no overall change in cardiac complications between the pre 2001 and post 2001 (15% vs. 14%, p=0.4) periods, a reduction in cardiac complications occurred in the highest risk CARPREG/WHO group (35% pre 2001 vs. 22% in the post 2001, p=0.025). Perinatal complication rate was not significantly different between the pre 2001 (32%) and the post 2001 period (31%).
Conclusions: During the past 20 years, pregnancy in women with heart disease has been associated with unchanged low maternal mortality. However, there continues to be significant morbidity in both mother and baby. The high perinatal complication rate highlights the need for new management strategies.
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:30 a.m.-11:40 a.m.
Session Title: Congenital Heart Disease: To the Third Decade and Beyond
Abstract Category: 9. Congenital Heart Disease: Adult
Presentation Number: 1131M-15
- 2017 American College of Cardiology Foundation