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Pregnancy Outcomes in Women With Heart Disease: The CARPREG II Study

Journal of the American College of Cardiology, 2018-05, Vol.71 (21), p.2419-2430 [Peer Reviewed Journal]

Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited May 29, 2018 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2018.02.076 ;PMID: 29793631

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Title:
Pregnancy Outcomes in Women With Heart Disease: The CARPREG II Study
Author: Silversides, Candice K ; Grewal, Jasmine ; Mason, Jennifer ; Sermer, Mathew ; Kiess, Marla ; Rychel, Valerie ; Wald, Rachel M ; Colman, Jack M ; Siu, Samuel C
Subjects: Adolescent ; Adult ; Cardiovascular disease ; Cohort Studies ; Complications ; Congenital diseases ; Coronary artery ; Coronary artery disease ; Cyanosis ; Edema ; Female ; Health risk assessment ; Health risks ; Heart ; Heart diseases ; Humans ; Hypertension ; Lung diseases ; Middle Aged ; Morbidity ; Multivariate analysis ; Pregnancy ; Pregnancy complications ; Pregnancy Complications, Cardiovascular - diagnosis ; Pregnancy Complications, Cardiovascular - epidemiology ; Pregnancy Complications, Cardiovascular - therapy ; Pregnancy Outcome - epidemiology ; Prospective Studies ; Pulmonary artery ; Rheumatic heart disease ; Risk ; Trends ; Ventricle ; Womens health ; Young Adult
Is Part Of: Journal of the American College of Cardiology, 2018-05, Vol.71 (21), p.2419-2430
Description: Identifying women at high risk is an important aspect of care for women with heart disease. This study sought to: 1) examine cardiac complications during pregnancy and their temporal trends; and 2) derive a risk stratification index. 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. 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]). 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.
Publisher: United States: Elsevier Limited
Language: English
Identifier: ISSN: 0735-1097
EISSN: 1558-3597
DOI: 10.1016/j.jacc.2018.02.076
PMID: 29793631
Source: Geneva Foundation Free Medical Journals at publisher websites
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Pregnancy Outcomes in Women With Heart Disease: The CARPREG II Study

Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited May 29, 2018 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2018.02.076 ;PMID: 29793631

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