Pregnancy Complication Rates Highest in Women With Pulmonary Arterial Hypertension

Pregnant women with heart disease have increased risks for maternal mortality and heart disease, according to results published in the European Heart Journal.

The rates of complications were highest among women with pulmonary arterial hypertension (PAH).

The study included pregnant women with heart disease who were prospectively enrolled in the Registry of Pregnancy and Cardiac Disease from 2007 to 2018 (n=5739). The primary outcome was maternal mortality or heart failure; secondary outcomes included other cardiac, obstetric and fetal complications.

The mean participant age was 29.5 years. Of all participants, 57% had congenital heart disease and 29% had valvular heart disease. Nearly half (44%) of participants delivered their children via Caesarean section.

The overall mortality rate was 0.6%. The researchers found that participants with PAH had the highest rate of mortality at 9%. Heart failure occurred in 11% of participants, and arrhythmias occurred in 2%. The rate of obstetric complications was 17% and 21% for fetal complications.

The results indicated that the number of high-risk pregnancies (modified World Health Organization Class IV) increased from 0.7% in 2007 to 2010 to 10.9% in 2015 to 2018.

The researchers found that pre-pregnancy heart failure, New York Heart Association >II, systemic ejection fraction <40%, modified World Health Organization Class IV, and anticoagulant use were independently associated with maternal complications.

“Further studies are required to assess the optimal management of these patients, with particular emphasis on cardiac medication use, including anticoagulation regimes and mode of delivery,” the researchers concluded.

Disclosures: Dr Maggioni reports receiving personal fees from Bayer, Novartis, and Fresenius. Dr Parsonage reports receiving personal fees from Pfizer. Dr Tavazzi reports receiving fees from Servier and CVIE Therapeutics. Dr Vahanian reports receiving fees from Abbott Vascular and Cardiovalve.

Reference

Roos-Hesselink J, Baris L, Johnson M, et al. Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry of Pregnancy and Cardiac disease (ROPAC). [published online March 25, 2019]. Eur Heart J. doi:10.1093/eurheartj/ehz136