Author + information
- Received October 26, 2017
- Revision received January 25, 2018
- Accepted February 27, 2018
- Published online May 21, 2018.
- Candice K. Silversides, MD, MSa,b,∗ (, )
- Jasmine Grewal, MDc,
- Jennifer Mason, RNa,b,
- Mathew Sermer, MDa,b,
- Marla Kiess, MDc,
- Valerie Rychel, MDd,
- Rachel M. Wald, MDa,b,
- Jack M. Colman, MDa,b and
- Samuel C. Siu, MD, SM, MBAa,b,e
- aDivision of Cardiology, University of Toronto Pregnancy and Heart Disease Research Program, Mount Sinai Hospital/Sinai Health System, and Toronto General Hospital/University Health Network, Toronto, Ontario, Canada
- bDepartment of Obstetrics & Gynaecology, Division of Maternal-Fetal Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- cDivision of Cardiology, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- dDepartment of Obstetrics and Gynecology, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- eDivision of Cardiology, University of Western Ontario, London, Ontario, Canada
- ↵∗Address for correspondence:
Dr. Candice K. Silversides, Cardiology, Mount Sinai Hospital, 700 University Avenue, Room 9-913, Toronto, Ontario M5G 1Z5, Canada.
Background Identifying women at high risk is an important aspect of care for women with heart disease.
Objectives This study sought to: 1) examine cardiac complications during pregnancy and their temporal trends; and 2) derive a risk stratification index.
Methods We prospectively enrolled consecutive pregnant women with heart disease and determined their cardiac outcomes during pregnancy. Temporal trends in complications were examined. A multivariate analysis was performed to identify predictors of cardiac complications and these were incorporated into a new risk index.
Results In total, 1,938 pregnancies were included. Cardiac complications occurred in 16% of pregnancies and were primarily related to arrhythmias and heart failure. Although the overall rates of cardiac complications during pregnancy did not change over the years, the frequency of pulmonary edema decreased (8% from 1994 to 2001 vs. 4% from 2001 to 2014; p value = 0.012). Ten predictors of maternal cardiac complications were identified: 5 general predictors (prior cardiac events or arrhythmias, poor functional class or cyanosis, high-risk valve disease/left ventricular outflow tract obstruction, systemic ventricular dysfunction, no prior cardiac interventions); 4 lesion-specific predictors (mechanical valves, high-risk aortopathies, pulmonary hypertension, coronary artery disease); and 1 delivery of care predictor (late pregnancy assessment). These 10 predictors were incorporated into a new risk index (CARPREG II [Cardiac Disease in Pregnancy Study]).
Conclusions Pregnancy in women with heart disease continues to be associated with significant morbidity, although mortality is rare. Prediction of maternal cardiac complications in women with heart disease is enhanced by integration of general, lesion-specific, and delivery of care variables.
- congenital heart disease
- heart failure
- risk score
- valve disease
This study was supported in part by operating grants provided by the Heart and Stroke Foundation of Canada (NA 5662), Canadian Institutes of Health Research (MOP 111139 and 119353), and the Canadian Foundation for Innovation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 26, 2017.
- Revision received January 25, 2018.
- Accepted February 27, 2018.
- 2018 American College of Cardiology Foundation
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