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Bay A, Berghammer M, Burström Å, Holstad Y, Christersson C, Dellborg M, Trzebiatowska-Krzynska A, Sörensson P, Thilén U, Johansson B. Symptoms during pregnancy in primiparous women with congenital heart disease. SCAND CARDIOVASC J 2024; 58:2302135. [PMID: 38192047 DOI: 10.1080/14017431.2024.2302135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024]
Abstract
Background: As more women with congenital heart disease (CHD) are reaching childbearing age, it becomes more common for their symptoms to be evaluated during pregnancy. However, pregnancy-related symptoms are similar to those caused by heart disease. This study investigated the prevalence of factors associated with symptoms during pregnancy in women with CHD. Methods: The national birth register was searched for primiparous women with CHD who were registered in the national quality register for patients with CHD. Results: Symptoms during the third trimester were reported in 104 of 465 evaluated women. The most common symptom was palpitations followed by dyspnea. Factors associated with symptoms were tested in a univariable model; higher NYHA classification (>1) (OR 11.3, 95%CI 5.5-23.2), low physical activity (≤3 h/week) (OR 2.1 95%CI 1.3-3.6) and educational level ≤ 12 years (OR 1.9 95%CI 1.2-3.0) were associated with having symptoms. In multivariable analysis, low physical activity level (OR 2.4 95%CI 1.2-5.0) and higher NYHA class (OR 11.3 95%CI 5.0-25.6) remained associated with symptoms during pregnancy. There were no cases with new onset of impaired systemic ventricular function during pregnancy. Conclusion: Symptoms during pregnancy are common in women with CHD but are often already present before pregnancy. Because ordinary symptoms during pregnancy often overlap with symptoms of heart disease, it is important to know if symptoms were present before pregnancy and if they became worse during pregnancy. These results should be included in pre-pregnancy counselling and considered in the monitoring during pregnancy.
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Affiliation(s)
- Annika Bay
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Malin Berghammer
- Institute of Health Sciences, University West and Queen Silvia Children Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Burström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Holstad
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Peder Sörensson
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Thilén
- Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden
| | - Bengt Johansson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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2
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English K, Frise C, Trinder J, Cauldwell M, Simpson M, Adamson D, Elton C, Burns G, Choudhary M, Nathanson M, Robert L, Moore J, O'Brien P, Pundir J. Best practice recommendations for medically assisted reproduction in patients with known cardiovascular disease or at high risk of cardiovascular disease. HUM FERTIL 2024; 27:2278295. [PMID: 38196173 DOI: 10.1080/14647273.2023.2278295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 01/11/2024]
Abstract
Increasing numbers of people are seeking assisted conception. In people with known cardiac disease or risk factors for cardiac disease, assisted conception may carry increased risks during treatment and any subsequent pregnancy. These risks should be assessed, considered and minimized prior to treatment.
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Affiliation(s)
- Kate English
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Charlotte Frise
- Department of Obstetrics, Queen Charlotte's and Chelsea Hospital, London, UK
| | | | | | | | - Dawn Adamson
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Chris Elton
- Department of Anaesthesia, Leicester Royal Infirmary, Leicester, UK
| | | | - Meenakshi Choudhary
- Newcastle Fertility Centre at Life, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mike Nathanson
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Leema Robert
- Department of Clinical Genetics, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Jim Moore
- Department of Primary Care, NHS Gloucestershire Clinical Commissioning Group, Brockworth, UK
| | - Pat O'Brien
- Department of Obstetrics, University College London, London, UK
| | - Jyotsna Pundir
- Reproductive Medicine, St Bartholomew's Hospital, London, UK
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3
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Wallet T, Legrand L, Isnard R, Gandjbakhch E, Pousset F, Proukhnitzky J, Dommergues M, Nizard J, Charron P. Pregnancy and cardiac maternal outcomes in women with inherited cardiomyopathy: interest of the CARPREG II risk score. ESC Heart Fail 2024; 11:1506-1514. [PMID: 38361389 PMCID: PMC11098662 DOI: 10.1002/ehf2.14694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024] Open
Abstract
AIMS Inherited cardiomyopathies are relatively rare but carry a high risk of cardiac maternal morbidity and mortality during pregnancy and postpartum. However, data for risk stratification are scarce. The new CARPREG II score improves prediction of prognosis in pregnancies associated with heart disease, though its role in inherited cardiomyopathies is unclear. We aim to describe characteristics and cardiac maternal outcomes in patients with inherited cardiomyopathy during pregnancy, and to evaluate the interest of the CARPREG II risk score in this population. METHODS AND RESULTS In this retrospective single-centre study, 90 consecutive pregnancies in 74 patients were included (mean age 32 ± 5 years), including 28 cases of dilated cardiomyopathy (DCM), 46 of hypertrophic cardiomyopathy, 11 of arrhythmogenic right ventricular cardiomyopathy and 5 of left ventricular noncompaction, excluding peripartum cardiomyopathy. The discriminatory power of several risk scores was assessed by the area under the receiver-operating characteristic curve (AUC). Median CARPREG II score was 2 [0;3] and was higher in the DCM subgroup. A severe cardiac maternal complication was observed in 18 (20%) pregnancies, mainly driven by arrhythmia and heart failure (each event in 10 pregnancies), with 3 cardiovascular deaths. Forty-three pregnancies (48%) presented foetal/neonatal complications (18 premature delivery, 3 foetal/neonatal death). CARPREG II was significantly associated with cardiac maternal complications (P < 0.05 for all) and showed a higher AUC (0.782) than CARPREG (0.755), mWHO (0.697) and ZAHARA (0.604). CONCLUSIONS Pregnancy in women with inherited cardiomyopathy carries a high risk of maternal cardiovascular complications. CARPREG II is the most efficient predictor of cardiovascular complications in this population.
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Affiliation(s)
- Thomas Wallet
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
- Sorbonne UniversityParisFrance
| | - Lise Legrand
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
| | - Richard Isnard
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
- Sorbonne UniversityParisFrance
| | - Estelle Gandjbakhch
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
- Sorbonne UniversityParisFrance
| | - Françoise Pousset
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
| | - Julie Proukhnitzky
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
- Sorbonne UniversityParisFrance
- Department of GeneticsAPHP, National Referral Center for Inherited Cardiac Diseases, Inserm UMR_1166ParisFrance
| | - Marc Dommergues
- Sorbonne UniversityParisFrance
- Department of Gynecology and ObstetricsAPHP, Pitié‐Salpêtrière HospitalParisFrance
| | - Jacky Nizard
- Sorbonne UniversityParisFrance
- Department of Gynecology and ObstetricsAPHP, Pitié‐Salpêtrière HospitalParisFrance
| | - Philippe Charron
- Department of Cardiology, APHP, ICAN (Institute of CardioMetabolism and Nutrition), Pitié‐Salpêtrière HospitalACTION Study groupParisFrance
- Sorbonne UniversityParisFrance
- Department of GeneticsAPHP, National Referral Center for Inherited Cardiac Diseases, Inserm UMR_1166ParisFrance
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4
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Opotowsky AR, Khairy P, Diller G, Kasparian NA, Brophy J, Jenkins K, Lopez KN, McCoy A, Moons P, Ollberding NJ, Rathod RH, Rychik J, Thanassoulis G, Vasan RS, Marelli A. Clinical Risk Assessment and Prediction in Congenital Heart Disease Across the Lifespan: JACC Scientific Statement. J Am Coll Cardiol 2024; 83:2092-2111. [PMID: 38777512 DOI: 10.1016/j.jacc.2024.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 05/25/2024]
Abstract
Congenital heart disease (CHD) comprises a range of structural anomalies, each with a unique natural history, evolving treatment strategies, and distinct long-term consequences. Current prediction models are challenged by generalizability, limited validation, and questionable application to extended follow-up periods. In this JACC Scientific Statement, we tackle the difficulty of risk measurement across the lifespan. We appraise current and future risk measurement frameworks and describe domains of risk specific to CHD. Risk of adverse outcomes varies with age, sex, genetics, era, socioeconomic status, behavior, and comorbidities as they evolve through the lifespan and across care settings. Emerging technologies and approaches promise to improve risk assessment, but there is also need for large, longitudinal, representative, prospective CHD cohorts with multidimensional data and consensus-driven methodologies to provide insight into time-varying risk. Communication of risk, particularly with patients and their families, poses a separate and equally important challenge, and best practices are reviewed.
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Affiliation(s)
- Alexander R Opotowsky
- Adult Congenital Heart Disease Program, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Paul Khairy
- Adult Congenital Heart Centre, Montreal Heart Institute, Montréal, Quebec, Canada
| | - Gerhard Diller
- Department of Cardiology III, University Hospital Münster, Münster, Germany
| | - Nadine A Kasparian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Heart and Mind Wellbeing Center, Cincinnati, Ohio, USA; Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James Brophy
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Keila N Lopez
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, Texas, USA
| | - Alison McCoy
- Vanderbilt Clinical Informatics Core, Department of Biomedical Informatics, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jack Rychik
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Thanassoulis
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Ramachandran S Vasan
- School of Public Health, University of Texas, San Antonio, Texas, USA; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, Quebec, Canada.
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5
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Braunwald E. Cardio-obstetrics: a new specialty. Eur Heart J 2024; 45:1589-1592. [PMID: 38569057 DOI: 10.1093/eurheartj/ehae202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Affiliation(s)
- Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Hale Building, Suite 7022, 60 Fenwood Road, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA
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6
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Cruz NC, Pham E, Ali H, Nanavati J, Steppan D, Kolb TM, Thomas AJ, Murphy J, Nyhan S, Grant MC, Steppan J. How severity and classification of pulmonary hypertension affect pregnancy outcomes: a systematic review and timeline. Int J Obstet Anesth 2024; 59:104210. [PMID: 38781778 DOI: 10.1016/j.ijoa.2024.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024]
Abstract
Women with pulmonary hypertension (PH) have increased mortality during pregnancy and the peripartum period. An increasing number of publications suggest improvements in maternal outcomes, so we conducted a systematic review focusing on disease severity and maternal survival. After screening 9097 potential studies from 1967 to 2021, we identified 66 relevant publications. Outcomes improved continuously over time and mortality fell from 11.6% in studies published before 2015 to 8.2% in studies published after 2015. Mortality was lower in patients with mild disease (0.8%) than in those with Eisenmenger syndrome (26.2%) or idiopathic pulmonary arterial hypertension (7.4-24.0%). One major drawback of the published studies is that they define severity using echocardiographic-estimated pulmonary artery pressures, without considering more contemporary parameters. This systematic review provides new insights for preconception counseling on pregnancy risks related to PH and suggests that PH classification and severity should be carefully considered in determining an individual's pregnancy-associated risk.
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Affiliation(s)
- N C Cruz
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - E Pham
- Department of Internal Medicine, Medstar Baltimore, Baltimore, MD, USA
| | - H Ali
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J Nanavati
- School of Global Health, University of Washington, Seattle, WA, USA
| | - D Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - T M Kolb
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - A J Thomas
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J Murphy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - S Nyhan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - M C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - J Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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7
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Seitler S, Ahmad M, Ahuja SAC, Ahmed MT, Stevenson A, Schreiber TR, Sodhi PS, Diyasena HK, Ogbeide O, Arularooran S, Shokraneh F, Cassandra M, Marijon E, Celermajer DS, Khanji MY, Providencia R. Routine Antenatal Echocardiography in High-Prevalence Areas of Rheumatic Heart Disease: A WHO-Guideline Systematic Review. Glob Heart 2024; 19:39. [PMID: 38681969 PMCID: PMC11049603 DOI: 10.5334/gh.1318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Background Rheumatic Heart Disease (RHD) is the most common cause of valvular heart disease worldwide. Undiagnosed or untreated RHD can complicate pregnancy and lead to poor maternal and fetal outcomes and is a significant factor in non-obstetric morbidity. Echocardiography has an emerging role in screening for RHD. We aimed to critically analyse the evidence on the use of echocardiography for screening pregnant women for RHD in high-prevalence areas. Methods We searched MEDLINE and Embase to identify the relevant reports. Two independent reviewers assessed the reports against the eligibility criteria in a double-blind process. Results The searches (date: 4 April 2023) identified 432 records for screening. Ten non-controlled observational studies were identified, five using portable or handheld echocardiography, comprising data from 23,166 women. Prevalence of RHD varied across the studies, ranging from 0.4 to 6.6% (I2, heterogeneity >90%). Other cardiac abnormalities (e.g., congenital heart disease and left ventricular systolic dysfunction) were also detected <1% to 2% of cases. Certainty of evidence was very low. Conclusion Echocardiography as part of antenatal care in high-prevalence areas may detect RHD or other cardiac abnormalities in asymptomatic pregnant women, potentially reducing the rates of disease progression and adverse labor-associated outcomes. However, this evidence is affected by the low certainty of evidence, and lack of studies comparing echocardiography versus standard antenatal care. Prospective Registration PROSPERO 2022 July 4; CRD42022344081 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=344081. Research question 'In areas with a high prevalence of rheumatic heart disease, should handheld echocardiography be added to routine antenatal care?'
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Affiliation(s)
- Samuel Seitler
- Royal Free Hampstead NHS Trust, Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Mahmood Ahmad
- Royal Free Hampstead NHS Trust, Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | | | | | - Alexander Stevenson
- Department of Cardiology, High Wycombe Hospital, Queen Alexandra Rd, High Wycombe HP11 2TT, UK
| | - Tamar Rachel Schreiber
- Royal Free Hampstead NHS Trust, Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Prem Singh Sodhi
- Royal Free Hampstead NHS Trust, Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Hiruna Kojitha Diyasena
- Royal Free Hampstead NHS Trust, Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Osarumwense Ogbeide
- Royal Free Hampstead NHS Trust, Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Sankavi Arularooran
- Royal Free Hampstead NHS Trust, Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK
| | - Farhad Shokraneh
- GENEs health and social care evidence SYnthesiS unit, Institute of Health Informatics, University College London, UK
- Evidence Synthesis, Systematic Review Consultants LTD, Nottingham, UK
| | | | - Eloi Marijon
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, FR
- Department of Cardiology, European Georges Pompidou Hospital, Paris, FR
| | - David S. Celermajer
- The University of Sydney, Sydney, AU
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, AU
| | - Mohammed Y. Khanji
- Cardiology Department, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Newham University Hospital, Barts Health NHS Trust, Glen Road, Plaistow, London E13 8SL, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University, London EC1A 7BE, UK
| | - Rui Providencia
- GENEs health and social care evidence SYnthesiS unit, Institute of Health Informatics, University College London, UK
- Cardiology Department, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Newham University Hospital, Barts Health NHS Trust, Glen Road, Plaistow, London E13 8SL, UK
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8
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Richardson M, Bonnet JP, Coulon C, Domanski O, Constans B, Estevez MG, Gautier S, Marsili L, Hamoud YO, Coisne A, Ridon H, Polge AS, Mouton S, Haddad Y, Juthier F, Moussa M, Vehier CM, Lemesle G, Schurtz G, Garabedian C, Jourdain M, Ninni S, Brigadeau F, Montaigne D, Lamblin N, Ghesquiere L. Management and outcomes of pregnant women with cardiovascular diseases in a cardio-obstetric team. Arch Cardiovasc Dis 2024:S1875-2136(24)00056-1. [PMID: 38644069 DOI: 10.1016/j.acvd.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are currently the leading cause of maternal death in Western countries. Although multidisciplinary cardio-obstetric teams are recommended to improve the management of pregnant women with CVD, data supporting this approach are scarce. AIMS To describe the characteristics and outcomes of pregnant patients with CVD managed within the cardio-obstetric programme of a tertiary centre. METHODS We included every pregnant patient with history of CVD managed by our cardio-obstetric team between June 2017 and December 2019, and collected all major cardiovascular events (death, heart failure, acute coronary syndromes, stroke, endocarditis and aortic dissection) that occurred during pregnancy, peripartum and the following year. RESULTS We included 209 consecutive pregnancies in 202 patients. CVDs were predominantly valvular heart diseases (37.8%), rhythm disorders (26.8%), and adult congenital heart diseases (22.5%). Altogether, 47.4% were classified modified World Health Organization (mWHO)>II, 66.5% had CARdiac disease in PREGnancy score (CARPREG II)≥2 and 80 pregnancies (38.3%) were delivered by caesarean section. Major cardiovascular events occurred in 16 pregnancies (7.7%, 95% confidence interval [CI] 4.5-12.2) during pregnancy and in three others (1.5%, 95% CI 0.3-4.1) during 1-year follow-up. Most events (63.1%) occurred in the 16.3% of patients with unknown CVD before pregnancy. CONCLUSIONS The management of pregnant patients with CVD within a cardio-obstetric team seems encouraging as we found a relatively low rate of cardiovascular events compared to the high-risk profile of our population. However, most of the remaining events occurred in patients without cardiac monitoring before pregnancy.
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Affiliation(s)
- Marjorie Richardson
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France.
| | - Jean Philippe Bonnet
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Capucine Coulon
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Olivia Domanski
- Department of Paediatrics and Congenital Heart Diseases, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Benjamin Constans
- Department of Anaesthesia, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Max Gonzalez Estevez
- Department of Anaesthesia, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Sophie Gautier
- Department of Pharmacology, Lille University Hospital, Lille, France
| | - Luisa Marsili
- Department of Clinical Genetic, Lille University Hospital, Lille, France
| | - Yasmine Ould Hamoud
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France
| | - Augustin Coisne
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Cardiovascular Research Foundation, New York, NY, USA; Inserm, U1011-EGID, Institut Pasteur de Lille, University of Lille, CHU de Lille, 59000 Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France
| | - Hélène Ridon
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Anne-Sophie Polge
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Stéphanie Mouton
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Yasmine Haddad
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Francis Juthier
- Faculté de médecine de Lille, université de Lille, Lille, France; Department of Surgery, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Inserm U1011, Institut Pasteur de Lille, Lille, France
| | - Mouhamed Moussa
- Department of Anaesthesia, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Claire Mounier Vehier
- Department of Vascular Medicine and Hypertension, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - Gilles Lemesle
- Faculté de médecine de Lille, université de Lille, Lille, France; Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France; FACT (French Alliance for Cardiovascular Trial), Paris, France
| | - Guillaume Schurtz
- Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France
| | - Charles Garabedian
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; METRICS, ULR 2694, Assessment of Health Technologies and Medical Practices, Lille, France
| | - Mercedes Jourdain
- Faculté de médecine de Lille, université de Lille, Lille, France; Intensive Care Unit, CHU de Lille, Lille, France; Inserm U1190, Lille, France
| | - Sandro Ninni
- Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France; Department of Cardiology, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - François Brigadeau
- Department of Cardiology, Heart and Lung Institute, Lille University Hospital, Lille, France
| | - David Montaigne
- Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Inserm, U1011-EGID, Institut Pasteur de Lille, University of Lille, CHU de Lille, 59000 Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France
| | - Nicolas Lamblin
- Faculté de médecine de Lille, université de Lille, Lille, France; Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France; Inserm U1167, Institut Pasteur de Lille, Lille, France
| | - Louise Ghesquiere
- Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; METRICS, ULR 2694, Assessment of Health Technologies and Medical Practices, Lille, France
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Rakisheva A, Sliwa K, Bauersachs J, Van Linthout S, Chopra VK, Bayes-Genis A, Fruzzetti F, Cannatà A, Deniau B, Mebazaa A, Savarese G, Ray R, Vitale C, Metra M, Rosano GMC. Multidisciplinary care of peripartum heart failure: A scientific statement of the Heart Failure Association of the ESC. Eur J Heart Fail 2024; 26:742-753. [PMID: 38679896 DOI: 10.1002/ejhf.3246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/22/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024] Open
Abstract
Heart failure is the most common cardiovascular complication during pregnancy and the postpartum period. It is associated with increased risk of maternal morbidity and mortality as well as potentially life-threatening foetal pathology. Management of heart failure in pregnancy requires expert knowledge of cardiovascular disease as well as obstetrics which underscores the importance of multidisciplinary cardio-obstetrics teams in order to optimize diagnosis, treatment and outcome. This includes counselling of women at risk before and during the course of pregnancy in order to strengthen the relationship between medical specialists and patients, as well as to allow patient-centred delivery of care and improve quality of life.
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Affiliation(s)
- Amina Rakisheva
- Department of Cardiology, City Cardiology Center, Almaty, Kazakhstan
- Qonaev City Hospital, Almaty, Kazakhstan
| | - Karen Sliwa
- Cape Heart Institute, Department of Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Sophie Van Linthout
- Berlin Institute of Health (BIH) at Charité - Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, Germany
| | | | - Antoni Bayes-Genis
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Franca Fruzzetti
- Department of Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy
| | - Antonio Cannatà
- King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Benjamin Deniau
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis - Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- FHU PROMICE, DMU Parabol, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, University Hospital Saint-Louis - Lariboisière, AP-HP, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Université de Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- FHU PROMICE, DMU Parabol, Paris, France
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Robin Ray
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, St George's Hospital, London, UK
| | - Cristiana Vitale
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's, University of London, St George's Hospital, London, UK
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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10
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Bruyère M, Morau E, Verspyck E. [Maternal mortality due to cardiovascular diseases in France 2016-2018]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:221-230. [PMID: 38373486 DOI: 10.1016/j.gofs.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 02/21/2024]
Abstract
Between 2016 and 2018, cardiovascular diseases were responsible for 41 deaths, making it the leading cause of maternal death within 42 days postpartum in France. The maternal mortality ratio (MMR) for cardiovascular disease is 1.8 per 100,000 NV, a non-significant increase compared with the 2013-2015 triennium (MMR of 1.5 per 100,000 NV). Deaths from cardiac causes accounted for the majority (n=28), with 26 deaths secondary to cardiac disease aggravated by pregnancy (indirect deaths) and 2 deaths related to peripartum cardiomyopathy (direct deaths). Deaths from vascular causes (n=13) corresponded to 9 aortic dissections and 4 ruptures of large vessels, including 3 ruptures of the splenic artery. Preventability of death (possible or probable) was found in 56% of cases compared with 66% in the previous triennium. Care was considered sub-optimal in 57% of cases, down from 72% in the 2013-2015 triennium. In women with known cardiovascular disease, the areas for improvement concern multidisciplinary follow-up, repeated assessment of the cardiovascular risk (WHO grade) and early referral to an expert centre (expert cardiologists, obstetricians, anaesthetists and intensive care). In all pregnant women or women who have recently given birth, a cardiovascular etiology should be considered in the presence of suggestive symptoms (dyspnea, chest or abdominal pain). Ultrasound "point of care" examination (fluid effusions, cardiac dysfunction) and cardiac enzymes assay can help in the diagnosis. Finally, the woman must be involved in her own care.
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Affiliation(s)
- Marie Bruyère
- Service d'anesthésie-réanimation et médecine périopératoire, hôpital Bicêtre, université Paris-Saclay, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
| | - Estelle Morau
- Département d'anesthésie-réanimation, hôpital universitaire Carémeau, place du Pr.-Robert-Debré, 30029 Nîmes cedex 9, France.
| | - Eric Verspyck
- Clinique gynécologique et obstétricale, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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11
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McCoy JA, Kim YY, Nyman A, Levine LD. Pregnancy-related cardiac outcomes among patients with congenital heart disease after formalization of a cardio-obstetrics program. Am J Obstet Gynecol MFM 2024; 6:101335. [PMID: 38460824 PMCID: PMC11081825 DOI: 10.1016/j.ajogmf.2024.101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND The prevalence of pregnant patients with congenital heart disease (CHD) is increasing, and these patients are at high risk for cardiac morbidity. OBJECTIVE This study aimed to examine the pregnancy outcomes in patients with congenital heart disease before and after the establishment of formal cardio-obstetrics collaboration between adult congenital heart disease and maternal-fetal medicine programs. STUDY DESIGN This was a retrospective cohort study of pregnant patients with congenital heart disease from 2002 to 2020 at a single urban academic institution in the United States. This study included patients with a singleton pregnancy who continued a pregnancy beyond 20 weeks of gestation. The primary outcome was a composite adverse maternal cardiac outcome, compared before (2002-2010) and after (2011-2020) the program. The secondary outcomes included gestational age at delivery, mode of delivery, rate of labor induction, use of diuresis after delivery, and a composite maternal morbidity outcome. RESULTS The number of pregnant patients with congenital heart disease increased after formalization of the cardio-obstetrics program (200 [postprogram group] vs 84 [preprogram group]; 0.48% of all deliveries in the postprogram group vs 0.25% of all deliveries in the preprogram group; P<.001). The postprogram group was more likely to undergo labor induction than the preprogram group (126 [63%] vs 34 [41%], respectively; P<.001). There were fewer patients in the postprogram group than in the preprogram group who were New York Heart Association class II to IV (23 [12%] vs 17 [22%], respectively; P=.04) or with systemic ventricular dysfunction (8 [4%] vs 12 [16%], respectively; P=.001). There was no difference in the primary outcome (38 [19%] in the postprogram group vs 14 [17%] in the preprogram group; P=.64), even after adjusting for confounders, including New York Heart Association class >I and systemic ventricular dysfunction (adjusted odds ratio, 2.3; 95% confidence interval, 0.96-5.4). Patients in the postprogram group were more likely to receive diuresis after delivery than patients in the preprogram group, even in the absence of heart failure or pulmonary edema (9 [4.5%] vs 0 [0.0%], respectively; P=.04). CONCLUSION In the period after the establishment of a formal cardio-obstetrics program between adult congenital heart disease and maternal-fetal medicine, the number of patients with congenital heart disease delivering at our institution increased significantly. Overall, fewer patients entered pregnancy with advanced-stage heart failure or systemic ventricular dysfunction, possibly suggesting improved prepregnancy cardiac care or improved preconception counseling. Composite maternal cardiac outcomes were similar, but the rates of postpartum diuresis increased significantly, suggesting increased attention to volume status in the postpartum period. Formalized collaboration between congenital heart disease and maternal-fetal medicine may help better optimize patients' care before conception, during pregnancy, and after delivery.
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MESH Headings
- Humans
- Female
- Pregnancy
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/complications
- Retrospective Studies
- Adult
- Pregnancy Outcome/epidemiology
- Pregnancy Complications, Cardiovascular/epidemiology
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy Complications, Cardiovascular/therapy
- Gestational Age
- Labor, Induced/statistics & numerical data
- Labor, Induced/methods
- United States/epidemiology
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Cohort Studies
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Affiliation(s)
- Jennifer A McCoy
- Maternal-Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs McCoy and Levine).
| | - Yuli Y Kim
- Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr Kim); Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Kim and Ms Nyman)
| | - Annique Nyman
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Kim and Ms Nyman)
| | - Lisa D Levine
- Maternal-Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Drs McCoy and Levine)
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12
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Tamirisa KP, Oliveros E, Paulraj S, Mares AC, Volgman AS. An Overview of Arrhythmias in Pregnancy. Methodist Debakey Cardiovasc J 2024; 20:36-50. [PMID: 38495654 PMCID: PMC10941715 DOI: 10.14797/mdcvj.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/27/2023] [Indexed: 03/19/2024] Open
Abstract
Cardiovascular disease significantly jeopardizes pregnancies in the United States, impacting 1% to 4% of pregnancies annually. Among complications, cardiac arrhythmias are prevalent, posing concerns for maternal and fetal health. The incidence of arrhythmias during pregnancy is rising, partly due to advances in congenital heart surgery and a growing population of women with structural heart disease. While most arrhythmias are benign, the increasing prevalence of more serious arrhythmias warrants a proactive approach. Guidance and reassurance suffice in many cases, but persistent symptoms require cautious use of antiarrhythmic drugs or other therapies for a safe outcome. Managing more serious arrhythmias requires a comprehensive, multidisciplinary approach involving specialists, including maternal-fetal medicine physicians, cardiologists, electrophysiologists, and anesthesiologists.
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13
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Dhiman S, Sharma A, Gupta A, Vatsa R, Bharti J, Kulshrestha V, Yadav S, Dadhwal V, Malhotra N. Fetomaternal outcomes in pregnant women with congenital heart disease: a comparative analysis from an apex institute. Obstet Gynecol Sci 2024; 67:218-226. [PMID: 38356351 PMCID: PMC10948205 DOI: 10.5468/ogs.23264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/28/2023] [Accepted: 01/21/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE With advancements in cardiac surgical interventions during infancy and childhood, the incidence of maternal congenital heart disease (CHD) is increasing. This retrospective study compared fetal and cardiac outcomes in women with and without CHD, along with a sub-analysis between cyanotic versus non-cyanotic defects and operated versus non-operated cases. METHODS A 10-year data were retrospectively collected from pregnant women with CHD and a 1:1 ratio of pregnant women without any heart disease. Adverse fetal and cardiac outcomes were noted in both groups. Statistical significance was set at P<0.05. RESULTS A total of 86 pregnant women with CHD were studied, with atrial septal defects (29.06%) being the most common. Out of 86 participants, 27 (31.39%) had cyanotic CHD. Around 55% of cases were already operated on for their cardiac defects. Among cardiovascular complications, 5.8% suffered from heart failure, 7.0% had pulmonary arterial hypertension, 8.1% presented in New York Heart Association functional class IV, 9.3% had a need for intensive care unit admission, and one experienced maternal mortality. Adverse fetal outcomes, including operative vaginal delivery, mean duration of hospital stay, fetal growth restriction, preterm birth (<37 weeks), low birth weight (<2,500 g), 5-minute APGAR score <7, and neonatal intensive care unit admissions, were significantly higher in women with CHD than in women without heart disease. CONCLUSION Women with CHD have a higher risk of adverse fetal and cardiac outcomes. The outcome can be improved with proper pre-conceptional optimization of the cardiac condition, good antenatal care, and multidisciplinary team management.
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Affiliation(s)
- Soniya Dhiman
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Akanksha Gupta
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Richa Vatsa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Juhi Bharti
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Vidushi Kulshrestha
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Satyavir Yadav
- Department of Cardiology, All India Institute of Medical Science, New Delhi,
India
| | - Vatsla Dadhwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
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14
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Ceuppens AS, De Meester P, Van De Bruaene A, Voigt JU, Van Calsteren K, Budts W, Troost E. Aorta pathology and pregnancy-related risks in adult congenital cardiac disease: does the aorta dilate during pregnancy? Obstet Med 2024; 17:41-46. [PMID: 38660320 PMCID: PMC11037198 DOI: 10.1177/1753495x231156851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/20/2023] [Indexed: 04/26/2024] Open
Abstract
Background Aortic dilatation and pregnancy are major concerns in women with aortopathy (AOP). This single-centre retrospective analysis focuses on the evolution of aortic diameters during and after pregnancy in women with Marfan syndrome (MS), Turner syndrome (TS) and bicuspid aortic valve (BAV) aortopathy. Methods and results Thirty-eight women who had one or more single pregnancies were included. The ascending aorta was measured during pregnancy and postpartum. During pregnancy, a significant increase of diameters of the sinus aortae (median 1.4 mm; [-1.3; 3.8]) and ascending aorta (median 2.1 mm; [0.0; 4.0]) was noted. Systemic hypertension gives dilation of the aorta, but it did not influence the overall trajectory during pregnancy. Conclusion Significant aortic dilatation is noted during pregnancy in women with underlying AOP, even persisting in the long term. Pre-existing systemic hypertension is associated with larger aortic diameters prior to pregnancy. More research on a larger study population however is needed.
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Affiliation(s)
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | | | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Els Troost
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Belgium
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15
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Nguyen AH, Murrin E, Moyo A, Sharma G, Sullivan SA, Maxwell GL, Kennedy JLW, Saad AF. Ischemic heart disease in pregnancy: a practical approach to management. Am J Obstet Gynecol MFM 2024; 6:101295. [PMID: 38278176 DOI: 10.1016/j.ajogmf.2024.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024]
Abstract
Ischemic heart disease is a crucial issue during pregnancy. The term is composed of both preexisting conditions and acute coronary syndrome in pregnancy, including pregnancy-associated myocardial infarction, which can have a significant effect on maternal and fetal outcomes. This review provides a complete guide to managing ischemic heart disease in pregnant women, emphasizing the importance of multidisciplinary care and individualized treatment strategies. Cardiovascular disease, particularly ischemic heart disease, is now the leading cause of maternal mortality worldwide. Pregnancy introduces unique physiological changes that increase the risk of acute myocardial infarction, with pregnancy-associated myocardial infarction cases often associated with factors, such as advanced maternal age, chronic hypertension, and preexisting cardiovascular conditions. This review distinguishes between preexisting ischemic heart disease and pregnancy-associated myocardial infarction. It will emphasize the various etiologies of pregnancy-associated myocardial infarction, including coronary atherosclerosis and plaque rupture presenting as ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and other nonatherosclerotic causes, including spontaneous coronary artery dissection, vasospasm, and embolism. Our study discusses the practical management of ischemic heart disease in pregnancy, with a focus on preconception counseling, risk assessment, and tailored antenatal planning for women with preexisting ischemic heart disease. Moreover, this document focuses on the challenges of diagnosing cardiovascular disease, especially when presented with nonclassical risk factors and presentation. It provides insight into the appropriate diagnostic testing methods, such as electrocardiogram, cardiac biomarkers, and echocardiography. In addition, the review covers various treatment strategies, from medical management to more invasive procedures, including coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft. Special attention is given to medication safety during pregnancy, including anticoagulation, beta-blockers, and antiplatelet agents. The complexities of delivery planning in women with ischemic heart disease are discussed, advocating for a multidisciplinary team-based approach and careful consideration of the timing and mode of delivery. Furthermore, the roles of breastfeeding and postpartum care are explored, emphasizing the long-term benefits and the suitability of various medications during lactation. Lastly, this review provides crucial insights into the management of ischemic heart disease in pregnancy, stressing the need for heightened awareness, prompt diagnosis, and tailored management to optimize maternal and fetal health outcomes.
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Affiliation(s)
- Andrew H Nguyen
- Department of Internal Medicine, Inova Fairfax Hospital, Falls Church, Virginia (Drs Nguyen and Moyo)
| | - Ellen Murrin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia (Drs Murrin, Sullivan, and Saad)
| | - Axucillia Moyo
- Department of Internal Medicine, Inova Fairfax Hospital, Falls Church, Virginia (Drs Nguyen and Moyo)
| | - Garima Sharma
- Department of Cardiology, Inova Schar Heart and Vascular Institute, Falls Church, Virginia (Drs Sharma and Kennedy)
| | - Scott A Sullivan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia (Drs Murrin, Sullivan, and Saad)
| | - George L Maxwell
- Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia (Dr Maxwell)
| | - Jamie L W Kennedy
- Department of Cardiology, Inova Schar Heart and Vascular Institute, Falls Church, Virginia (Drs Sharma and Kennedy)
| | - Antonio F Saad
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia (Drs Murrin, Sullivan, and Saad).
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16
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Blissett S, Alphonsus L, Eastabrook G, Banner H, Siu SC. Designing a Multidisciplinary Cardio-obstetrics Curriculum for General Cardiology and Obstetrics Residents: A National Survey of Educational Needs. CJC Open 2024; 6:174-181. [PMID: 38487046 PMCID: PMC10935673 DOI: 10.1016/j.cjco.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/10/2023] [Indexed: 03/17/2024] Open
Abstract
Background The increasing and potentially preventable cardiac events in pregnant patients have led to calls to enhance multidisciplinary cardio-obstetrics education. To design a multidisciplinary cardio-obstetrics curriculum for general cardiology and obstetrics and gynecology (OBGYN) residents, we need to define educational needs from the perspectives of both cardiology and OBGYN residents. Our study characterizes the educational needs of Canadian cardiology and OBGYN residents. Methods Canadian cardiology and OBGYN residents were surveyed on clinical exposures, perceived needs for topics, unperceived needs for topics (multiple-choice questions) and preferences for educational formats. High priorities were defined as ≥ 50% of responses indicating a perceived need or ≥ 50% indicating an unperceived need. Results A total of 154 residents participated (cardiology n = 44, OBGYN n = 110). Residents reported insufficient clinical exposure to nearly all cardiac disorders, with 33% of exposures occurring in multidisciplinary contexts. All topics aside from gestational hypertension were rated as high priority on perceived needs by both specialties. High-priority unperceived needs were congenital heart disease (both specialties), pre-existing acquired heart disease (both specialties), medication safety (OBGYN), peripartum management (OBGYN), and pregnancy-related heart disease (OBGYN). Cardiology and OBGYN residents shared preferences for in-person simulation, virtual simulation, and online modules. Conclusions Residents in both specialties reported low clinical exposure to most cardiac disorders during pregnancy, identified high-priority perceived needs in multiple topics, and shared 2 high-priority unperceived needs. OBGYN residents identified 3 additional high-priority unperceived needs. These data can inform design of multidisciplinary cardio-obstetrics curricula for general cardiology and OBGYN residents.
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Affiliation(s)
- Sarah Blissett
- Department of Medicine, Division of Cardiology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Centre for Education Research & Innovation (CERI), Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Lotus Alphonsus
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Genevieve Eastabrook
- Department of Obstetrics and Gynecology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Harrison Banner
- Department of Obstetrics and Gynecology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Samuel C. Siu
- Department of Medicine, Division of Cardiology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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17
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Muñoz-Ortiz E, Miranda-Arboleda AF, Saavedra-González YA, Gándara-Ricardo JA, Velásquez-Penagos J, Giraldo-Ardila N, Zapata-Montoya M, Holguín-Gonzalez E, Villegas-García F, Senior-Sanchez JM. Characterization of cardiac arrhythmias and maternal-fetal outcomes in pregnant women: A prospective cohort study. Rev Port Cardiol 2024; 43:67-74. [PMID: 37923244 DOI: 10.1016/j.repc.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Cardiovascular disease is a common cause of morbidity and mortality in pregnant women. Arrhythmias are common complications during pregnancy; however, the data are limited. Our goal was to characterize the epidemiology, clinical presentation, and impact of cardiac arrhythmias on maternal-fetal outcomes. METHODS A prospective cohort study from the Colombian Registry of Pregnancy and Cardiovascular Disease was carried out from 2016 to 2019. All patients with tachyarrhythmia or bradyarrhythmia and a minimum follow-up of six months after delivery were included. The primary outcome was a composite of cardiac events defined as pulmonary edema, symptomatic sustained arrhythmia requiring specific therapy, stroke, cardiac arrest, or maternal death. Secondary outcomes were other cardiac, neonatal, and obstetric events. RESULTS Arrhythmias were the most common cause of referral to our dedicated cardio-obstetric clinic. A total of 92 patients were included, mean age 27±6 years; 8.7% had previous structural heart disease, and cardiology consultation was delayed in 79.4%. The most common arrhythmias were premature ventricular contractions (33%) and paroxysmal reentrant supraventricular tachycardias (15%); 11 patients (12%) had cardiac implantable electronic devices. Cardiac events occurred in 18.4% of patients, obstetric events occurred in 6.5%, and one caesarean was indicated in the context of symptomatic severe mitral stenosis. Adverse neonatal outcomes were observed in 24.3% of newborns. CONCLUSIONS Arrhythmias were the most common cause of referral to a dedicated cardio-obstetric clinic; most had a benign course. Adverse maternal cardiovascular outcomes were significant and there was a high rate of obstetric and neonatal adverse events, underlining the importance of multidisciplinary care.
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Affiliation(s)
- Edison Muñoz-Ortiz
- Clínica Cardio-obstétrica, Hospital Universitario de San Vicente Fundación, Medellín, Antioquia, Colombia; Sección de Cardiología, Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Antioquia, Colombia; Grupo Para el Estudio de las Enfermedades Cardiovasculares - GEEC, Universidad de Antioquia, Medellín, Antioquia, Colombia.
| | | | | | - Jairo Alfonso Gándara-Ricardo
- Clínica Cardio-obstétrica, Hospital Universitario de San Vicente Fundación, Medellín, Antioquia, Colombia; Sección de Cardiología, Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Antioquia, Colombia; Grupo Para el Estudio de las Enfermedades Cardiovasculares - GEEC, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Jesús Velásquez-Penagos
- Clínica Cardio-obstétrica, Hospital Universitario de San Vicente Fundación, Medellín, Antioquia, Colombia; Departamento de Ginecología y Obstetricia, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | | | - Magnolia Zapata-Montoya
- Clínica Cardio-obstétrica, Hospital Universitario de San Vicente Fundación, Medellín, Antioquia, Colombia
| | - Erica Holguín-Gonzalez
- Clínica Cardio-obstétrica, Hospital Universitario de San Vicente Fundación, Medellín, Antioquia, Colombia
| | - Francisco Villegas-García
- Clínica Cardio-obstétrica, Hospital Universitario de San Vicente Fundación, Medellín, Antioquia, Colombia; Servicio de Cardiología, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
| | - Juan Manuel Senior-Sanchez
- Clínica Cardio-obstétrica, Hospital Universitario de San Vicente Fundación, Medellín, Antioquia, Colombia; Sección de Cardiología, Departamento de Medicina Interna, Universidad de Antioquia, Medellín, Antioquia, Colombia; Grupo Para el Estudio de las Enfermedades Cardiovasculares - GEEC, Universidad de Antioquia, Medellín, Antioquia, Colombia
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de Brito Pitilin E, Marafon F, da Silva Rosa Bonadiman B, Pelazza BB, Pillat MM, de Lara JD, de Oliveira PP, Bagatini MD, Schirmer J. Effects of calcium supplementation on changes in the IL2, IL4, IL6, IL10 axes and oxidative stress in pregnant women at risk for pre-eclampsia. BMC Pregnancy Childbirth 2024; 24:71. [PMID: 38245691 PMCID: PMC10799391 DOI: 10.1186/s12884-023-06235-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Pregnant women with hypertensive disorders are at increased risk for inflammatory diseases and oxidative stress. The dilemma raised by the best dosage of calcium supplementation on these factors is evident. The aim of the current study was to examine the effects of calcium on biomarkers of the purinergic system, inflammation and oxidative stress, which are factors contributing to vascular damage in pregnant women at high risk of pre-eclampsia. METHODS A prospective, double-blind and placebo-controlled study conducted with 101 women at risk of pre-eclampsia were randomized to take 500 mg calcium/day or 1,500 mg calcium/day or placebo for 6 weeks from the 20th gestational week until delivery. Fasting blood samples were collected at the beginning of the study and 6 weeks after the intervention. RESULTS Taking calcium supplements (500 mg calcium/day) led to a significant increase in ATP hydrolysis (p < 0.05), NTPDase activity with increased hydrolysis of ADP and AMP nucleotides in platelets and lymphocytes. In the intragroup analysis IL-2, IL-6, IL-4 and interferon-ɣ presented lower values in the calcium 1,500 mg/day group (p < 0.005). Oxidative stress was assessed by TBARS pro-oxidant marker, with an increase for the calcium groups when compared to the placebo group. The Vitamin C antioxidant marker presented a significant increase (p < 0.005) for the group that received high calcium doses. CONCLUSIONS Calcium administration for 6 weeks had antioxidant action and positively modulated the purinergic system and inflammatory markers in pregnant women at risk of pre-eclampsia.
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Grants
- The research protocol was submitted to the National Council for Scientific and Technological Development (CNPq) and granted financial support, according to public notice 28/2018 – Universal of the Ministry of Science, Technology, Innovations and Communications/National Council for Scientific and Technological Development (Ministério de Ciência, Tecnologia, Inovações e Comunicações, MCTIC/CNPq).
- This paper was also funded by the Support Fund for the Maintenance and Development of Higher Education (Fundo de Apoio à Manutenção e ao Desenvolvimento da Educação Superior, FUMDES). The study funders did not play any role in the study design, data collection, data analysis, data interpretation or writing of the report.
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Affiliation(s)
- Erica de Brito Pitilin
- Graduate Program in Nursing, Federal University of Fronteira Sul, Chapecó, Santa Catarina, Brazil
| | - Filomena Marafon
- Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó, Santa Catarina, Brazil
| | | | - Bruno Bordin Pelazza
- Graduate Program in Nursing, Midwest State University, Guarapuava, Paraná, Brazil.
| | - Micheli Mainardi Pillat
- Graduate Program in Pharmaceutical Sciences, Department of Microbiology and Parasitology, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, Brazil
| | - Jéssica Dotto de Lara
- Graduate Program in Pharmaceutical Sciences, Department of Microbiology and Parasitology, Federal University of Santa Maria, Santa Maria, Rio Grande Do Sul, Brazil
| | | | - Margarete Dulce Bagatini
- Graduate Program in Nursing, Federal University of Fronteira Sul, Chapecó, Santa Catarina, Brazil
- Graduate Program in Biomedical Sciences, Federal University of Fronteira Sul, Chapecó, Santa Catarina, Brazil
| | - Janine Schirmer
- Graduate Program in São Paulo School of Nursings, Federal University of São Paulo, São Paulo, SP, Brazil
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Liu JL, Wang Q, Qu DY. Postpartum quality of life and mental health in women with heart disease: Integrated clinical communication and treatment. World J Psychiatry 2024; 14:63-75. [PMID: 38327887 PMCID: PMC10845230 DOI: 10.5498/wjp.v14.i1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/06/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Postpartum quality of life (QoL) in women with heart disease has been neglected. AIM To improve clinical communication and treatment, we integrated medical data and subjective characteristics to study postpartum QoL concerns. METHODS The study assessed QoL 6 wk after birth using the 12-Item Short-Form Health Survey. The Edinburgh Postnatal Depression Scale, Cardiac Anxiety Questionnaire, European Heart Failure Self-Care Behavior Scale, and a self-designed questionnaire based on earlier research were also used to assess patient characteristics. Patient data were collected. Prediction models were created using multiple linear regression. RESULTS This retrospective study examined postpartum QoL in 105 cardiac patients. Postpartum QoL scores were lower (90.69 ± 13.82) than those of women without heart disease, with physical component scores (41.09 ± 9.91) lower than mental component scores (49.60 ± 14.87). Postpartum depression (33.3%), moderate anxiety (37.14%), pregnancy concerns (57.14%), offspring heart problems (57.14%), and life expectancy worries (48.6%) were all prevalent. No previous cardiac surgery, multiparity, higher sadness and cardiac anxiety, and fear of unfavorable pregnancy outcomes were strongly related to lower QoL (R2 = 0.525). CONCLUSION Postpartum QoL is linked to physical and mental health in women with heart disease. Our study emphasizes the need for healthcare workers to recognize the unique characteristics of these women while developing and implementing comprehensive management approaches during their maternity care.
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Affiliation(s)
- Jia-Lin Liu
- Department of Obstetrics and Gynecology, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Qi Wang
- Department of Psychiatry, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Dong-Ying Qu
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
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20
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Mogos MF, Muchira JM, Park C, Osmundson S, Piano MR. Age-Stratified Sex Differences in Heart Failure With Preserved Ejection Fraction Among Adult Hospitalizations. J Cardiovasc Nurs 2024:00005082-990000000-00163. [PMID: 38200643 DOI: 10.1097/jcn.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND There is evidence that heart failure with preserved ejection fraction (HFpEF)-related hospitalizations are increasing in the United States. However, there is a lack of knowledge about HFpEF-related hospitalizations among younger adults. OBJECTIVE The aims of this study were to perform a retrospective analysis using the Nationwide Inpatient Sample and to examine age-stratified sex differences in the prevalence, correlates, and outcomes of HFpEF-related hospitalization across the adult life span. METHOD Using the Nationwide Inpatient Sample (2002-2014), patient and hospital characteristics were determined. Joinpoint regression was used to describe age-stratified sex differences in the annual average percent change of hospitalizations with HFpEF. Survey logistic regression was used to estimate adjusted odds ratios representing the association of sex with HFpEF-related hospitalization and in-hospital mortality. RESULTS There were 8 599 717 HFpEF-related hospitalizations (2.43% of all hospitalizations). Women represented the majority (5 459 422 [63.48%]) of HFpEF-related adult hospitalizations, compared with men (3 140 295 [36.52%]). Compared with men younger than 50 years, women within the same age group were 6% to 28% less likely to experience HFpEF-related hospitalization. Comorbidities such as hypertensive heart disease, renal disease, hypertension, obstructive sleep apnea, atrial fibrillation, obesity, anemia, and pulmonary edema explained a greater proportion of the risk of HFpEF-related hospitalization in adults younger than 50 years than in adults 50 years or older. CONCLUSION Before the age of 50 years, women exhibit lower HFpEF-related hospitalization than men, a pattern that reverses with advancing age. Understanding and addressing the factors contributing to these sex-specific differences can have several potential implications for improving women's cardiovascular health.
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21
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Greer OYO, Anandanadesan R, Shah NM, Price S, Johnson MR. Cardiogenic shock in pregnancy. BJOG 2024; 131:127-139. [PMID: 37794623 DOI: 10.1111/1471-0528.17645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/06/2023] [Accepted: 08/20/2023] [Indexed: 10/06/2023]
Abstract
Cardiac disease complicates 1%-4% of pregnancies globally, with a predominance in low and middle-income countries (LMICs). Increasing maternal age, rates of obesity, cardiovascular comorbidities, pre-eclampsia and gestational diabetes all contribute to acquired cardiovascular disease in pregnancy. Additionally, improved survival in congenital heart disease (CHD) has led to increasing numbers of women with CHD undergoing pregnancy. Implementation of individualised care plans formulated through pre-conception counselling and based on national and international guidance have contributed to improved clinical outcomes. However, there remains a significant proportion of women of reproductive age with no apparent comorbidities or risk factors that develop heart disease during pregnancy, with no indication for pre-conception counselling. The most extreme manifestation of cardiac disease is cardiogenic shock (CS), where the primary cardiac pathology results in inadequate cardiac output and hypoperfusion, and is associated with significant mortality and morbidity. Key to management is early recognition, intervention to treat any potentially reversible underlying pathology and supportive measures, up to and including mechanical circulatory support (MCS). In this narrative review we discuss recent developments in the classification of CS, and how these may be adapted to improve outcomes of pregnant women with, or at risk of developing, this potentially lethal condition.
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Affiliation(s)
- Orene Y O Greer
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Rathai Anandanadesan
- Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Department of Critical Care, King's College Hospital, London, UK
| | - Nishel M Shah
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Susanna Price
- Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Mark R Johnson
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Chelsea & Westminster NHS Foundation Trust, London, UK
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22
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Vinsard PA, Arendt KW, Sharpe EE. Care for the Obstetric Patient with Complex Cardiac Disease. Adv Anesth 2023; 41:53-69. [PMID: 38251622 DOI: 10.1016/j.aan.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The prevalence of cardiac disease-related maternal morbidity and mortality is on the rise in the United States. To ensure safe management of pregnancy in patients with cardiovascular disease, pre-delivery evaluation by a multidisciplinary Pregnancy Heart Team should occur. Appropriate anesthetic, cardiac, and obstetric care are essential. Risk stratification tools evaluate the etiology and severity of cardiovascular disease to determine the appropriate hospital type and location for delivery and anesthetic management. Intrapartum hemodynamic monitoring may need to be intensified, and neuraxial analgesia and anesthesia are generally appropriate. The anesthesiologist must be prepared for obstetric and cardiac emergencies.
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Affiliation(s)
- Patrice A Vinsard
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Katherine W Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Emily E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Fu R, Li Y, Li X, Jiang W. Hypertensive Disorders in Pregnancy: Global Burden From 1990 to 2019, Current Research Hotspots and Emerging Trends. Curr Probl Cardiol 2023; 48:101982. [PMID: 37479005 DOI: 10.1016/j.cpcardiol.2023.101982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
Hypertensive disorders in pregnancy (HDP) constitute a worldwide health problem for pregnant women and their infants. This study provided HDP burden over 1990 to 2019 by region and age distribution, and predicted changes in related values for the next 25 years. We then conducted an econometric analysis of the author distribution, collaborative networks, keyword burst clustering, and spatio-temporal analysis of HDP-related publications from 2012 to 2022 to access current scientific developments and hotspots. The number of pregnant women with HDP has been increasing over the past 30 years, with regional and age-stratified differences in the burden of disease. Additionally, projections suggest an increase of deaths due to maternal HDP among adolescents younger than 20 years. Current research is mostly centered on pre-eclampsia, with hot keywords including trophoblast, immune tolerance, frozen-thawed embryo transfer, aspirin, gestational diabetes association, and biomarkers. Researches on the pathological mechanism, classification, and subtypes of HDP need to be further advanced.
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Affiliation(s)
- Ru Fu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yihui Li
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaogang Li
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Weihong Jiang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China.
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24
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Allen-Davis W, Hylton M, Gibson S, Rattray C, Johnson N, Hunter TA. Pregnancy outcomes of women with cardiac disease. Int J Gynaecol Obstet 2023; 163:1005-1011. [PMID: 37697807 DOI: 10.1002/ijgo.15068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/05/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To determine and predict the maternal and neonatal outcomes of pregnancies occurring in patients with cardiac disease. METHOD This retrospective review included 147 pregnancies identified from antenatal, delivery, and nursery records. Information concerning the nature and severity of the pre-existing cardiac disease, comorbidities, risk scores, obstetric or cardiac complications, and pregnancy outcomes were collected. The data were analyzed using SPSS Windows version 22. RESULTS In all, 111 (73.5%) of the cohort had acquired heart disease and 4 (2.7%) of patients belonged to WHO class IV, in which pregnancy is not recommended. Additionally, 12 (8.1%) were categorized as being at significant risk of having a cardiac complication. The proportion of patients that had maternal and perinatal mortality was 6 (4.0%) and 7 (4.8%), respectively. The WHO and CARPREG scoring systems were reliably able to predict cardiac events (P < 0.01). Mothers who received preconception counseling had significantly fewer occurrences of cardiac and obstetric events than those who did not. CONCLUSION Cardiac disease in pregnancy in women managed at our center was most often an acquired disease. The baseline risk assessment scores accurately predicted the likelihood of adverse cardiac outcomes.
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Affiliation(s)
- Wendy Allen-Davis
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Melesia Hylton
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Shanea Gibson
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Carole Rattray
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Nadine Johnson
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
| | - Tiffany A Hunter
- Department of Obstetrics and Gynaecology, University of the West Indies, Kingston, Jamaica
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25
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Xing YY, Ruan Y, Qin H, Zhao L, Zhao Q, Wei Y, Chen J, Ma X. Effects of maternal pulmonary arterial hypertension on fetal hemodynamics and maternal-fetal outcome in late pregnancy. Echocardiography 2023; 40:1339-1349. [PMID: 37922228 DOI: 10.1111/echo.15708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 09/15/2023] [Accepted: 10/19/2023] [Indexed: 11/05/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the effects of maternal pulmonary arterial hypertension (PAH) on fetal hemodynamics in the third trimester and to identify hemodynamic indicators associated with adverse maternal and fetal outcomes. METHODS We recruited 48 pregnant women with PAH in the third trimester and 32 women with normal pregnancies as controls matched for age and gestational week. Fetal growth and hemodynamic parameters were assessed by two-dimensional and color Doppler. All cases were followed up until delivery and maternal and fetal outcomes were collected. High throughput sequencing method was used to determine differential miRNA patterns in plasma exposed to pulmonary arterial hypertension (PAH) in pregnant women. We then performed the validated of key differentially expressed miRNAs by real-time PCR. RESULTS Compared with the normal and mild PAH groups, resistance index (RI), pulsatility index (PI) of the fetal umbilical artery (UA) and quantitative ductus venosus (QDV) blood flow were increased in subjects with moderate to severe PAH, while PI and the ratio of peak systolic velocity (PSV) to end-diastolic velocity (EDV) (S/D) of the middle cerebral artery (MCA) were decreased. Compared with the normal group, subjects in the mild and moderate PAH groups had lower neonatal weight, shorter neonatal height, and higher preterm birth rates. In addition, miRNA sequencing data showed that PAH affected the levels of 23 miRNAs in plasma. At the same time, we showed that PAH significantly decreased the level of miR-1255a and increased the level of miR-548ar-3p by real-time PCR. CONCLUSION In the group of pregnant women with moderate to severe pulmonary hypertension, there was a higher proportion of preterm births and low birth weight babies. Hemodynamic changes in the fetal UA, MCA, and ductus venosus (DV) during late pregnancy were associated with adverse fetal outcomes. At the same time, miRNA sequencing results showed that miR-1255a and miR-548ar-3p may play an important role in the development of PAH.
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Affiliation(s)
- Yuan Yuan Xing
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yanping Ruan
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Huai Qin
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Lei Zhao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Qing Zhao
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yun Wei
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jie Chen
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xiaohai Ma
- Department of Interventional Diagnosis and Treatment, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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26
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Wedlund F, von Wowern E, Hlebowicz J. Increased cesarean section rate and premature birth according to modified WHO maternal cardiovascular risk in pregnant women with congenital heart disease. PLoS One 2023; 18:e0294323. [PMID: 37971983 PMCID: PMC10653484 DOI: 10.1371/journal.pone.0294323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND During pregnancy and delivery, hemodynamics are altered and complex congenital heart disease has been associated with adverse maternal and neonatal outcomes. We sought to investigate pregnancy outcome and complications in relation to complexity of heart condition. MATERIALS AND METHODS We studied women with ACHD discussed at multidisciplinary conferences at Lund University Hospital March 2009-May 2021. We studied 149 pregnancies in 101 women. We scored each woman retrospectively according to the modified World Health Organization (mWHO) risk classification and included patients in risk class I (n = 36, 24.1%), II (n = 43, 28.9%), II-III (n = 43, 28.9%), III (n = 24, 16.1%) and IV (n = 3, 2.0%). RESULTS Women with mWHO class ≥III underwent cesarean section more often than women in less complex mWHO classes, (OR, 5.1; 95% CI, 2.0-12.5; p<0.001). The odds of premature delivery were significantly higher among pregnant women with mWHO class ≥III (OR, 6.7; 95% CI, 2.6-17.4; p<0.001). We found no difference in incidence of preeclampsia, gestational hypertension, gestational diabetes, hemorrhage >1000 ml or cardiac defect in the neonate depending on WHO-class. Women in mWHO classes III-IV had a higher rate of fetal growth restriction (FGR) compared to women in mWHO classes I, II, II-III (p<0.007). CONCLUSIONS Our findings indicate that women with more complex heart disease (mWHO classes III or IV) tend to have a higher rate of cesarean section, premature birth and FGR.
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Affiliation(s)
- Frida Wedlund
- Department of Cardiology, Skåne University Hospital, Lund University, Malmö, Sweden
- Clinical Sciences, Lund University, Lund, Sweden
| | - Emma von Wowern
- Institution of Clinical Sciences Malmö, Perinatal and Cardiovascular Epidemiology, Lund University, Lund, Sweden
- Dept. of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Joanna Hlebowicz
- Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
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27
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Panah LG, Menachem JN, Boos EW, Lindley KJ. Pregnancy and Adult Congenital Heart Disease in a Post-Roe World. J Card Fail 2023; 29:1556-1560. [PMID: 37973315 DOI: 10.1016/j.cardfail.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Lindsay G Panah
- From the Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan N Menachem
- From the Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN
| | - Elise W Boos
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Kathryn J Lindley
- From the Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
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28
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Davis MB, Bello NA, Berlacher K, Harrington CM, Lin JP, Lindley KJ, Panah LG, Park KE, Silversides CK, Walsh MN, Weissman G, DeFaria Yeh D, Damp JB. Cardiovascular Fellowship Training in Cardio-Obstetrics: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 82:1792-1803. [PMID: 37879784 DOI: 10.1016/j.jacc.2023.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 10/27/2023]
Abstract
The United States has the highest maternal mortality in the developed world with cardiovascular disease as the leading cause of pregnancy-related deaths. In response to this, the emerging subspecialty of cardio-obstetrics has been growing over the past decade. Cardiologists with training and expertise in caring for patients with cardiovascular disease in pregnancy are essential to provide effective, comprehensive, multidisciplinary, and high-quality care for this vulnerable population. This document provides a blueprint on incorporation of cardio-obstetrics training into cardiovascular disease fellowship programs to improve knowledge, skill, and expertise among cardiologists caring for these patients, with the goal of improving maternal and fetal outcomes.
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Affiliation(s)
- Melinda B Davis
- Department of Medicine, Division of Cardiovascular Medicine and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
| | - Natalie A Bello
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kathryn Berlacher
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Colleen M Harrington
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeannette P Lin
- Division of Cardiology, Ahmanson/Adult Congenital Heart Disease Center, University of California Los Angeles, California, USA
| | - Kathryn J Lindley
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsay G Panah
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ki E Park
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Candice K Silversides
- Division of Cardiology, University of Toronto Pregnancy and Heart Disease Research Program, Mount Sinai and Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mary Norine Walsh
- Heart Failure and Cardiac Transplantation Program, Ascension St Vincent Heart Center, Indianapolis, Indiana, USA
| | - Gaby Weissman
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Doreen DeFaria Yeh
- Division of Cardiology, Adult Congenital Heart Disease Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie B Damp
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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29
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 123] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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30
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Sharma G, Mehta A, Scott NS. Risk Estimation in Valvular Heart Disease in Pregnancy: An Idea Whose Time Has Come. J Am Coll Cardiol 2023; 82:1407-1410. [PMID: 37758435 DOI: 10.1016/j.jacc.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Garima Sharma
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, Virginia, USA.
| | - Aditya Mehta
- Inova Schar Heart and Vascular, Inova Health System, Falls Church, Virginia, USA
| | - Nandita S Scott
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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31
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Osteen K, Tucker CA, Meraz R. We Have to Really Decide: The Childbearing Decisions of Women With Congenital Heart Disease. J Cardiovasc Nurs 2023:00005082-990000000-00131. [PMID: 37747321 DOI: 10.1097/jcn.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Medical management and surgical improvement techniques permit persons with congenital heart conditions to live longer. Adults with congenital heart disease (CHD) have more childbearing options than previously available to them. However, there is an increased childbearing risk associated with certain types of CHD. Minimal investigation has been given to the childbearing decision-making experiences and adaptation of women with CHD. OBJECTIVE The aim of this study was to gain insight into the childbearing decision-making and adaptation experiences of women with CHD. METHODS Using a narrative inquiry approach, 17 adult women with CHD of any severity, of childbearing age, who had, within the last 5 years, made a decision regarding childbearing, were interviewed. In this study, we applied the key components of the Roy Adaptation Model to understand childbearing decision-making experiences and their adaptation. Data were analyzed using thematic analysis. RESULTS Data analysis revealed 5 stages of childbearing decision making: (1) prologue: stimulus to consider childbearing; (2) exploring childbearing options; (3) considering childbearing options; (4) choosing to bear or not to bear a child; and (5) epilogue: adapting to the childbearing decision. Adaptation occurred in the areas of self-concept (ie, emotional adaptation), role function (ie, relational adaptation), and interdependence (ie, interactional adaptation). CONCLUSION Childbearing decision making is a complex personal decision that is carefully and deliberately made. Women with CHD long for children and seek childbearing information from various resources and may experience grief regarding the inability to bear children. A greater understanding of childbearing decision making can be useful in addressing women's childbearing emotions and assist with adaptation to childbearing needs.
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Paulo DG, Mutagaywa R, Mayala H, Barongo A. Pregnancy risk and contraception among reproductive-age women with rheumatic heart disease attending care at a tertiary cardiac center in Tanzania: a hospital-based cross-sectional study. BMC Womens Health 2023; 23:404. [PMID: 37653369 PMCID: PMC10468869 DOI: 10.1186/s12905-023-02332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/05/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains prevalent in the developing world and reproductive-age women are disproportionately affected. It is among the common est cardiac diseases during pregnancy and is associated with poor pregnancy outcomes. Despite its importance among reproductive-age women, there are no local studies that characterize the clinical characteristics, risk of poor pregnancy outcomes and contraception which represents one effective way to prevent unplanned pregnancies in this population. METHODS This was a hospital-based descriptive cross-sectional study. Non-pregnant reproductive-age women with echocardiographically diagnosed RHD were consecutively recruited from in- and out-patients units of the Jakaya Kikwete Cardiac Institute (JKCI). A clinical research form was used to gather socio-demographic, clinical characteristics, contraception status and echocardiographic information. The maternal/pregnancy risk class was determined using the modified World Health Organization (WHO) classification of maternal risk. RESULTS Two hundred thirty-eight women of reproductive age with RHD were recruited. The median age (range) was 36 years (15-49). Two-thirds were dyspneic on moderate exertion and 17.2% had New York Heart Association class IV heart failure. A quarter had atrial fibrillation/flutter. On echocardiography, mitral regurgitation was the most common valvular lesion (68.1%), followed by mitral stenosis (66.8%), and 12.2% of participants had reduced left ventricular ejection fraction. Two-thirds (66%) had a high pregnancy risk (class IV) based on the modified WHO classification system. The proportion of participants using contraception was 7.1% and common methods were: bilateral tubal ligation 5 of 17 (29.4%) and hormonal implant (4 of 17). The most common reason for the choice of a method was safety, 10 out of 17 (58.8%). CONCLUSION The majority of women of reproductive age with RHD in our hospital cohort are at the highest pregnancy risk based on the modified WHO classification and a very small proportion of them are on contraception. These results call for action among clinicians to offer counselling to these patients, educating them on their risk and offering appropriate contraception advice while waiting for definitive interventions.
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Affiliation(s)
- David G Paulo
- Department of Internal Medicine, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.
| | - Reuben Mutagaywa
- Department of Internal Medicine, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Henry Mayala
- Jakaya Kikwete Cardiac Institute, Dar Es Salaam, Tanzania
| | - Aileen Barongo
- Mwananyamala Regional Referral Hospital, Dar Es Salaam, Tanzania
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Almeida MCCD, Marques-Santos C, Costa MENC, Castro MLD, Carvalho RCMD. Cardiovascular diseases in women: a differentiated view and risk stratification. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S106. [PMID: 37556625 PMCID: PMC10411705 DOI: 10.1590/1806-9282.2023s106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 08/11/2023]
Abstract
Cardiovascular diseases are the main cause of mortality in men and women worldwide, surpassing mortality from all associated neoplasms. In women, its prevalence and mortality increase at menopause, but complications of reproductive age, such as preeclampsia and eclampsia, lead to increased cardiovascular risk throughout their lives. Coronary ischemic disease is is the leading cause of death in Brazil and worldwide, with atherosclerotic disease being the principal pathophysiological mechanism. However, in women, other mechanisms are associated with myocardial ischemia, such as microcirculation disease and/or vasospasm, due to the anatomical and hormonal characteristics of women in different stages of their lives. Knowledge of the most prevalent cardiovascular diseases in women, as well as the specific risk factors, the traditional ones with the greatest impact, and the under-recognized ones, is of fundamental importance in their risk stratification, diagnosis, and management, fundamentally aiming at reducing mortality.
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Affiliation(s)
- Maria Cristina Costa de Almeida
- Medicina Centro Universitário Belo Horizonte, Ciências da Saúde Universidade Federal de Minas Gerais, Sociedade Brasileira de Cardiologia, Departamento de Cardiologia da Mulher/Sociedade Brasileira de Cardiologia - Belo Horizonte (MG), Brazil
| | - Celi Marques-Santos
- Cardiologia Universidade Tiradentes, Ciências da Saúde Universidade Federal de Sergipe, Sociedade Brasileira de Cardiologia, European Society of Cardiology - Aracaju (SE), Brazil
| | - Maria Elizabeth Navegantes Caetano Costa
- Cardiologia pela Universidade Federal de São Paulo, Sociedade Brasileira de Cardiologia, Centro Universitário Metropolitano da Amazônia, European Society of Cardiology - São Paulo (SP), Brazil
| | - Marildes Luiza de Castro
- Sociedade Brasileira de Cardiologia, Ciências da Saúde UFMG, Delegada Sociedade Interamericana de Cardiologia para o Brazil - Belém (PA), Brazil
| | - Regina Coeli Marques de Carvalho
- Universidade Federal Ceará, Universidade do Rio Grande do Sul, Cardiologia Sociedade Brasileira de Cardiologia - Recife (PE), Brazil
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Nehme L, Ye P, Huang JC, Kawakita T. Decision and economic analysis of hostile abortion laws compared with supportive abortion laws. Am J Obstet Gynecol MFM 2023; 5:101019. [PMID: 37178721 DOI: 10.1016/j.ajogmf.2023.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND On June 24, 2022, the US Supreme Court overturned Roe v Wade in Dobbs v Jackson Women's Health Organization. Therefore, several states banned abortion, and other states are considering more hostile abortion laws. OBJECTIVE This study aimed to assess the incidence of adverse maternal and neonatal outcomes in the hypothetical cohort where all states have hostile abortion laws compared with the pre-Dobbs v Jackson cohort (supportive abortion laws cohort) and examine the cost-effectiveness of these policies. STUDY DESIGN This study developed a decision and economic analysis model comparing the hostile abortion laws cohort with the supportive abortion laws cohort in a sample of 5.3 million pregnancies. Cost (inflated to 2022 US dollars) estimates were from a healthcare provider's perspective, including immediate and long-term costs. The time horizon was set to a lifetime. Probabilities, costs, and utilities were derived from the literature. The cost-effectiveness threshold was set to be at $100,000 per quality-adjusted life year. Probabilistic sensitivity analyses using the Monte Carlo simulation with 10,000 simulations were performed to assess the robustness of our results. The primary outcomes included maternal mortality and an incremental cost-effectiveness ratio. The secondary outcomes included hysterectomy, cesarean delivery, hospital readmission, neonatal intensive care unit admission, neonatal mortality, profound neurodevelopmental disability, and incremental cost and effectiveness. RESULTS In the base case analysis, the hostile abortion laws cohort had 12,911 more maternal mortalities, 7518 more hysterectomies, 234,376 more cesarean deliveries, 102,712 more hospital readmissions, 83,911 more neonatal intensive care unit admissions, 3311 more neonatal mortalities, and 904 more cases of profound neurodevelopmental disability than the supportive abortion laws cohort. The hostile abortion laws cohort was associated with more cost ($109.8 billion [hostile abortion laws cohort] vs $75.6 billion [supportive abortion laws cohort]) and 120,749,900 fewer quality-adjusted life years with an incremental cost-effectiveness ratio of negative $140,687.60 than the supportive abortion laws cohort. Probabilistic sensitivity analyses suggested that the chance of the supportive abortion laws cohort being the preferred strategy was more than 95%. CONCLUSION When states consider enacting hostile abortion laws, legislators should consider an increase in the incidence of adverse maternal and neonatal outcomes.
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Affiliation(s)
- Lea Nehme
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita)
| | - Peggy Ye
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC (Dr Ye); Georgetown University School of Medicine, Washington, DC (Dr Ye)
| | - Jim C Huang
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (Dr Huang)
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita).
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Lee SI, Hanley S, Vowles Z, Plachcinski R, Azcoaga-Lorenzo A, Taylor B, Nelson-Piercy C, McCowan C, O'Reilly D, Hope H, Abel KM, Eastwood KA, Locock L, Singh M, Moss N, Brophy S, Nirantharakumar K, Thangaratinam S, Black M. Key outcomes for reporting in studies of pregnant women with multiple long-term conditions: a qualitative study. BMC Pregnancy Childbirth 2023; 23:551. [PMID: 37528358 PMCID: PMC10391909 DOI: 10.1186/s12884-023-05773-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/10/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Maternal multiple long-term conditions are associated with adverse outcomes for mother and child. We conducted a qualitative study to inform a core outcome set for studies of pregnant women with multiple long-term conditions. METHODS Women with two or more pre-existing long-term physical or mental health conditions, who had been pregnant in the last five years or planning a pregnancy, their partners and health care professionals were eligible. Recruitment was through social media, patients and health care professionals' organisations and personal contacts. Participants who contacted the study team were purposively sampled for maximum variation. Three virtual focus groups were conducted from December 2021 to March 2022 in the United Kingdom: (i) health care professionals (n = 8), (ii) women with multiple long-term conditions (n = 6), and (iii) women with multiple long-term conditions (n = 6) and partners (n = 2). There was representation from women with 20 different physical health conditions and four mental health conditions; health care professionals from obstetrics, obstetric/maternal medicine, midwifery, neonatology, perinatal psychiatry, and general practice. Participants were asked what outcomes should be reported in all studies of pregnant women with multiple long-term conditions. Inductive thematic analysis was conducted. Outcomes identified in the focus groups were mapped to those identified in a systematic literature search in the core outcome set development. RESULTS The focus groups identified 63 outcomes, including maternal (n = 43), children's (n = 16) and health care utilisation (n = 4) outcomes. Twenty-eight outcomes were new when mapped to the systematic literature search. Outcomes considered important were generally similar across stakeholder groups. Women emphasised outcomes related to care processes, such as information sharing when transitioning between health care teams and stages of pregnancy (continuity of care). Both women and partners wanted to be involved in care decisions and to feel informed of the risks to the pregnancy and baby. Health care professionals additionally prioritised non-clinical outcomes, including quality of life and financial implications for the women; and longer-term outcomes, such as children's developmental outcomes. CONCLUSIONS The findings will inform the design of a core outcome set. Participants' experiences provided useful insights of how maternity care for pregnant women with multiple long-term conditions can be improved.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Stephanie Hanley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Louise Locock
- Health Services Research Unit, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ngawai Moss
- Patient and public representative, London, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
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Abdurrahman L. Women with congenital heart disease: Maternal and neonatal health. Curr Probl Pediatr Adolesc Health Care 2023:101398. [PMID: 37479598 DOI: 10.1016/j.cppeds.2023.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Lubabatu Abdurrahman
- Chief, Division of Cardiology, Dayton Children's Hospital, One Children's Plaza, Clinical Assistant Professor, Pediatrics, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, 45404, USA.
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Su Z, Zhang Y, Cai X, Li Q, Gu H, Luan Y, He Y, Li S, Chen J, Zhang H. Improving long-term care and outcomes of congenital heart disease: fulfilling the promise of a healthy life. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:502-518. [PMID: 37301214 DOI: 10.1016/s2352-4642(23)00053-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/16/2023] [Accepted: 02/28/2023] [Indexed: 06/12/2023]
Abstract
Advances in the prevention, diagnosis, and treatment for congenital heart disease (CHD), the most common birth defect in China, have drastically improved survival for individuals with the disease. However, China's current health system is not well prepared to manage the growing population of people with CHD and their complex medical needs, which range from early detection of the condition and intervention for physical, neurodevelopmental, and psychosocial impairment, to long-term management of major complications and chronic health problems. Health disparities caused by long-standing regional differences in access to care pose challenges when major complications such as pulmonary hypertension arise, and when individuals with complex CHD become pregnant and give birth. Currently, no data sources track neonates, children, adolescents, and adults with CHD in China and delineate their clinical characteristics and use of health resources. This scarcity of data should warrant attention from the Chinese Government and relevant specialists in the field. In the third paper of the Series on CHD in China, we summarise key literature and current data to identify knowledge gaps and call for concerted efforts by the government, hospitals, clinicians, industries, and charitable organisations to develop an actionable, lifelong framework of congenital cardiac care that is accessible and affordable for all individuals with CHD. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Zhanhao Su
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Department of Cardiovascular Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yunting Zhang
- Child Health Advocacy Institute, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoman Cai
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qiangqiang Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Yihua He
- Maternal-Fetal Medicine Centre in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China; Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center and State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of South China, Structural Heart Disease, Guangzhou, China
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Wolfe NK. We Can Do Better: Reproductive Health Counseling for Women with Congenital Heart Disease and Disabilities. J Womens Health (Larchmt) 2023; 32:734-735. [PMID: 36989513 DOI: 10.1089/jwh.2023.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Affiliation(s)
- Natasha K Wolfe
- Department of Internal Medicine and Pediatrics, Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Wander G, van der Zande JA, Patel RR, Johnson MR, Roos-Hesselink J. Pregnancy in women with congenital heart disease: a focus on management and preventing the risk of complications. Expert Rev Cardiovasc Ther 2023; 21:587-599. [PMID: 37470417 DOI: 10.1080/14779072.2023.2237886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Congenital heart disease (CHD) is the most common cardiac disorder in pregnancy in the western world (around 80%). Due to improvements in surgical interventions more women with CHD are surviving to adulthood and choosing to become pregnant. AREAS COVERED Preconception counseling, antenatal management of CHDs and strategies to prevent maternal and fetal complications.Preconception counseling should start early, before the transition to adult care and be offered to both men and women. It should include the choice of contraception, lifestyle modifications, pre-pregnancy optimization of cardiac state, the chance of the child inheriting a similar cardiac lesion, the risks to the mother, and long-term prognosis. Pregnancy induces marked physiological changes in the cardiovascular system that may precipitate cardiac complications. Risk stratification is based on the underlying cardiac disease and data from studies including CARPREG, ZAHARA, and ROPAC. EXPERT OPINION Women with left to right shunts, regurgitant lesions, and most corrected CHDs are at lower risk and can be managed in secondary care. Complex CHD, including systemic right ventricle need expert counseling in a tertiary center. Those with severe stenotic lesions, pulmonary artery hypertension, and Eisenmenger's syndrome should avoid pregnancy, be given effective contraception and managed in a tertiary center if pregnancy does happen.
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Affiliation(s)
- Gurleen Wander
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Johanna A van der Zande
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roshni R Patel
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Mark R Johnson
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Pollock A, Kiernan TJ. Contemporary management of infective endocarditis in pregnancy. Expert Rev Cardiovasc Ther 2023; 21:839-854. [PMID: 37915203 DOI: 10.1080/14779072.2023.2276891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Infective endocarditis (IE) during pregnancy is a rare condition that is associated with a high level of morbidity and mortality. The epidemiology, diagnosis, treatment, and prognosis have changed significantly in the last two decades. The declining incidence of rheumatic heart disease, improved life expectancy with congenital heart disease, advances in cardiac surgery and cardiac devices, rise in resistant microorganisms, complications of the opioid epidemic, and increasing maternal age are some of the many factors contributing to these changes. AREAS COVERED This article explores existing literature on the topic including case reports, case series, registry data, and clinical guidelines. The focus of this article is the evolving epidemiology, predisposing factors and preventative measures, clinical presentation, investigation, management, and potential complications of IE in pregnancy. EXPERT OPINION Robust prospective data on the management of IE in pregnancy is lacking, and obtaining these data will be very challenging. It is imperative that international registries are used to provide data on best clinical practices and inform future clinical guidelines. Multimodal imaging should be incorporated in the investigation of complicated cases. A multidisciplinary approach to the management of this rare and life-threatening condition is essential to ensure the best outcomes for both the mother and the fetus.
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Affiliation(s)
- Ailís Pollock
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Thomas J Kiernan
- Department of Cardiology, University Hospital Limerick, Dooradoyle, Limerick, Ireland
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Mansoori GA, Mahmeed WA, Wani S, Salih BT, Ansari TE, Farook F, Farooq Z, Khair H, Zaręba K, Dhahouri NA, Raj A, Foo RS, Ali BR, Jasmi FA, Akawi N. Introducing and Implementing Genetic Assessment in Cardio-Obstetrics Clinical Practice: Clinical and Genetic Workup of Patients with Cardiomyopathy. Int J Mol Sci 2023; 24:ijms24119119. [PMID: 37298070 DOI: 10.3390/ijms24119119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023] Open
Abstract
Cardiovascular disease (CVD) during pregnancy varies significantly worldwide, influenced by factors such as access to healthcare, delayed diagnosis, causes, and risk factors. Our study sought to explore the spectrum of CVD present in pregnant women in the United Arab Emirates to better understand this population's unique needs and challenges. Central to our study is an emphasis on the importance of implementing a multidisciplinary approach that involves the collaboration of obstetricians, cardiologists, geneticists, and other healthcare professionals to ensure that patients receive comprehensive and coordinated care. This approach can also help identify high-risk patients and implement preventive measures to reduce the occurrence of adverse maternal outcomes. Furthermore, increasing awareness among women about the risk of CVD during pregnancy and obtaining detailed family histories can help in the early identification and management of these conditions. Genetic testing and family screening can also aid in identifying inherited CVD that can be passed down through families. To illustrate the significance of such an approach, we provide a comprehensive analysis of five women's cases from our retrospective study of 800 women. The findings from our study emphasize the importance of addressing maternal cardiac health in pregnancy and the need for targeted interventions and improvements in the existing healthcare system to reduce adverse maternal outcomes.
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Affiliation(s)
- Ghadeera Al Mansoori
- Department of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi 11001, United Arab Emirates
| | - Wael Al Mahmeed
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Abu Dhabi 112412, United Arab Emirates
| | - Saleema Wani
- Department of Obstetrics & Gynecology, Corniche Hospital, Abu Dhabi 3788, United Arab Emirates
| | - Bashir Taha Salih
- Department of Obstetrics & Gynecology, Corniche Hospital, Abu Dhabi 3788, United Arab Emirates
| | - Tarek El Ansari
- Department of Obstetrics & Gynecology, Corniche Hospital, Abu Dhabi 3788, United Arab Emirates
| | - Fathima Farook
- Department of Obstetrics & Gynecology, Corniche Hospital, Abu Dhabi 3788, United Arab Emirates
| | - Zenab Farooq
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi 127788, United Arab Emirates
| | - Howaida Khair
- Department of Obstetrics & Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Kornelia Zaręba
- Department of Obstetrics & Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Nahid Al Dhahouri
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Anjana Raj
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Roger S Foo
- Cardiovascular Research Institute, National University Healthcare Systems, Singapore 117599, Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore 138672, Singapore
| | - Bassam R Ali
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Fatma Al Jasmi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Nadia Akawi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
- Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
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Lv C, Wu L, Liao G, Huang Y, Chen J, Jiang S, Chen D, Gao Y. Maternal and fetal/neonatal outcomes of pregnancies complicated by pulmonary hypertension: a retrospective study of 154 patients. Clinics (Sao Paulo) 2023; 78:100194. [PMID: 37119592 PMCID: PMC10173387 DOI: 10.1016/j.clinsp.2023.100194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/12/2023] [Accepted: 03/27/2023] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVES To determine the main clinical and demographic outcomes related to Pulmonary Hypertension (PH) and adverse obstetric and fetal/neonatal outcomes. METHODS This study retrospectively analyzed the medical record data of 154 patients with PH who were admitted to the Third Affiliated Hospital of Guangzhou Medical University between January 2011 and December 2020. RESULTS According to the severity of elevated Pulmonary Artery Systolic Pressure (PASP), 82 women (53.2%) were included in the mild PH group, 34 (22.1%) were included in the moderate PH group, and 38 (24.7%) were included in the severe PH group. There were significant differences in the incidence of heart failure, premature delivery, Very-Low-Birth-Weight (VLBW) infants, and Small-for-Gestational-Age (SGA) infants among the three PH groups (p < 0.05). Five (3.2%) women died within 7-days after delivery, 7 (4.5%) fetuses died in utero, and 3 (1.9%) neonates died. The authors found that PASP was an independent risk factor for maternal mortality. After adjustment for age, gestational weeks, systolic blood pressure, Body Mass Index (BMI), mode of delivery, and anesthesia, the risk of maternal mortality in the severe PH group was 20.21 times higher than that in the mild-moderate PH group (OR = 21.21 [95% CI 1.7∼264.17]), p < 0.05. All 131 (85.1%) patients were followed up for 12 months postpartum. CONCLUSIONS The authors found that the risk of maternal mortality in the severe PH group was significantly higher than that in the mild-moderate group, highlighting the importance of pulmonary artery pressure screening before pregnancy, early advice on contraception, and multidisciplinary care.
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Affiliation(s)
- Chengtian Lv
- Department of Respiratory and Critical Care Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lichan Wu
- Department of Critical Care Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guangyuan Liao
- Department of Critical Care Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuwen Huang
- Department of Respiratory and Critical Care Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jingyi Chen
- The Third Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Shuyi Jiang
- The Third Clinical College of Guangzhou Medical University, Guangzhou, China
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, Department of Fetal Medicine and Prenatal Diagnosis, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanmei Gao
- Department of Respiratory and Critical Care Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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43
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Ntiloudi D, Giannakoulas G. Cardiomyopathy and pregnancy: a high-risk combination. Evid Based Nurs 2023:ebnurs-2022-103583. [PMID: 36931701 DOI: 10.1136/ebnurs-2022-103583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Despoina Ntiloudi
- Cardiology Department, Tzaneio General Hospital of Piraeus, Piraeus, Greece
| | - George Giannakoulas
- AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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44
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Meng ML, Arendt KW, Banayan JM, Bradley EA, Vaught AJ, Hameed AB, Harris J, Bryner B, Mehta LS. Anesthetic Care of the Pregnant Patient With Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e657-e673. [PMID: 36780370 DOI: 10.1161/cir.0000000000001121] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The pregnancy-related mortality rate in the United States is excessively high. The American Heart Association is dedicated to fighting heart disease and recognizes that cardiovascular disease, preexisting or acquired during pregnancy, is the leading cause of maternal mortality in the United States. Comprehensive scientific statements from cardiology and obstetrics experts guide the treatment of cardio-obstetric patients before, during, and after pregnancy. This scientific statement aims to highlight the role of specialized cardio-obstetric anesthesiology care, presenting a systematic approach to the care of these patients from the anesthesiology perspective. The anesthesiologist is a critical part of the pregnancy heart team as the perioperative physician who is trained to prevent or promptly recognize and treat patients with peripartum cardiovascular decompensation. Maternal morbidity is attenuated with expert anesthesiology peripartum care, which includes the management of neuraxial anesthesia, inotrope and vasopressor support, transthoracic echocardiography, optimization of delivery location, and consideration of advanced critical care and mechanical support when needed. Standardizing the anesthesiology approach to patients with high peripartum cardiovascular risk and ensuring that cardio-obstetrics patients have access to the appropriate care team, facilities, and advanced cardiovascular therapies will contribute to improving peripartum morbidity and mortality.
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45
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Majmundar M, Doshi R, Patel KN, Zala H, Kumar A, Kalra A. Prevalence, trends, and outcomes of cardiovascular diseases in pregnant patients in the USA: 2010-19. Eur Heart J 2023; 44:726-737. [PMID: 36342471 DOI: 10.1093/eurheartj/ehac669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
AIMS Contemporary data on the prevalence, trends, and outcomes of cardiovascular diseases (CVDs) in pregnant patients are limited. This study aimed to analyse the prevalence, trends, and outcomes of CVD and their subtypes in hospitalized pregnant patients in the USA. METHODS AND RESULTS This retrospective population-based cohort study used the Nationwide Readmission Database to identify all hospitalized pregnant patients from 1 January 2010, to 31 December 2019. Data analyses were conducted from January to February 2022. Pregnancy-associated hospitalizations were identified. The main outcomes were the prevalence and trend of CVD in pregnant patients. 39 212 104 hospitalized pregnant patients were identified: 4 409 924 with CVD (11.3%) and 34 802 180 without CVD (88.8%). The annual age-adjusted CVD prevalence increased from 9.2% in 2010 to 14.8% in 2019 (P < 0.001). Hypertensive disorder of pregnancy (1069/10 000) was the most common, and aortic dissection (0.1/10 000) was the least common CVD. The trends of all CVD subtypes increased; however, the trend of valvular heart disease decreased. Age-adjusted in-hospital all-cause mortality was 8.2/10 000 in CVD, but its trend decreased from 8.1/10 000 in 2010 to 6.5/10 000 in 2019 (P < 0.001). CVD was associated with 15.51 times higher odds of in-hospital all-cause mortality compared with non-CVD patients [odds ratio (OR): 15.51, 95% confidence interval (CI)13.22-18.20, P < 0.001]. CVD was associated with higher 6-week postpartum readmission (OR: 1.97, 95% CI: 1.95-1.99), myocardial infarction (OR: 3.04, 95% CI: 2.57-3.59), and stroke (OR: 2.66, 95% CI: 2.41-2.94)(P < 0.001 for all). CONCLUSION There is an increasing age-adjusted trend in overall CVD and its subtypes among pregnant patients in the USA from 2010 to 2019. Pregnant patients with CVD had higher odds of in-hospital mortality than those without CVD. However, in-hospital all-cause mortality among patients with and without CVD has decreased over the past 10 years. CVD was associated with higher 6-week postpartum all-cause readmission, myocardial infarction, and stroke rates.
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Affiliation(s)
- Monil Majmundar
- Department of Cardiology, University of Kansas Medical Center, Kansas, KS, USA
| | - Rajkumar Doshi
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, NJ, USA
| | - Kunal N Patel
- Department of Internal Medicine, Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Harshvardhan Zala
- Department of Clinical Research, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ankur Kalra
- Franciscan Health Lafayette East, 3900 St. Francis Way, Ste 200, Lafayette, IN 47905, USA
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46
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Lee SI, Hope H, O'Reilly D, Kent L, Santorelli G, Subramanian A, Moss N, Azcoaga-Lorenzo A, Fagbamigbe AF, Nelson-Piercy C, Yau C, McCowan C, Kennedy JI, Phillips K, Singh M, Mhereeg M, Cockburn N, Brocklehurst P, Plachcinski R, Riley RD, Thangaratinam S, Brophy S, Hemali Sudasinghe SPB, Agrawal U, Vowles Z, Abel KM, Nirantharakumar K, Black M, Eastwood KA. Maternal and child outcomes for pregnant women with pre-existing multiple long-term conditions: protocol for an observational study in the UK. BMJ Open 2023; 13:e068718. [PMID: 36828655 PMCID: PMC9972454 DOI: 10.1136/bmjopen-2022-068718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION One in five pregnant women has multiple pre-existing long-term conditions in the UK. Studies have shown that maternal multiple long-term conditions are associated with adverse outcomes. This observational study aims to compare maternal and child outcomes for pregnant women with multiple long-term conditions to those without multiple long-term conditions (0 or 1 long-term conditions). METHODS AND ANALYSIS Pregnant women aged 15-49 years old with a conception date between 2000 and 2019 in the UK will be included with follow-up till 2019. The data source will be routine health records from all four UK nations (Clinical Practice Research Datalink (England), Secure Anonymised Information Linkage (Wales), Scotland routine health records and Northern Ireland Maternity System) and the Born in Bradford birth cohort. The exposure of two or more pre-existing, long-term physical or mental health conditions will be defined from a list of health conditions predetermined by women and clinicians. The association of maternal multiple long-term conditions with (a) antenatal, (b) peripartum, (c) postnatal and long-term and (d) mental health outcomes, for both women and their children will be examined. Outcomes of interest will be guided by a core outcome set. Comparisons will be made between pregnant women with and without multiple long-term conditions using modified Poisson and Cox regression. Generalised estimating equation will account for the clustering effect of women who had more than one pregnancy episode. Where appropriate, multiple imputation with chained equation will be used for missing data. Federated analysis will be conducted for each dataset and results will be pooled using random-effects meta-analyses. ETHICS AND DISSEMINATION Approval has been obtained from the respective data sources in each UK nation. Study findings will be submitted for publications in peer-reviewed journals and presented at key conferences.
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Affiliation(s)
- Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Lisa Kent
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | | | - Ngawai Moss
- Patient and Public Representative, London, UK
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, University of St Andrews School of Medicine, St Andrews, UK
- Instituto de Investigación Sanitaria Fundación Jimenez Diaz, Hospital Rey Juan Carlos, Mostoles, Spain
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, University of St Andrews School of Medicine, St Andrews, UK
- Department of Epidemiology and Medical Statistics, University of Ibadan College of Medicine, Ibadan, Nigeria
| | | | - Christopher Yau
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Health Data Research UK, London, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, University of St Andrews School of Medicine, St Andrews, UK
| | | | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Megha Singh
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mohamed Mhereeg
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Richard D Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, University of Birmingham Institute of Metabolism and Systems Research, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | | | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, University of St Andrews School of Medicine, St Andrews, UK
| | - Zoe Vowles
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kathryn Mary Abel
- Centre for Women's Mental Health, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Mairead Black
- Aberdeen Centre for Women's Health Research, University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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47
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Chin KM, Santiago-Munoz P. Pregnancy and Congenital Heart Disease-Associated Pulmonary Hypertension: Are Outcomes Improving? Circulation 2023; 147:562-564. [PMID: 36780392 DOI: 10.1161/circulationaha.122.063191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- Kelly M Chin
- Department of Internal Medicine, Pulmonary and Critical Care Medicine (K.M.C.), University of Texas Southwestern Medical Center, Dallas
| | - Patricia Santiago-Munoz
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine (P.S.-M.), University of Texas Southwestern Medical Center, Dallas
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48
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Roos-Hesselink JW, van der Zande JA, Johnson MR. Pregnancy outcomes in women with heart disease: how to improve? Eur Heart J 2023; 44:1541-1543. [PMID: 36748201 DOI: 10.1093/eurheartj/ehad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rg-435-PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johanna A van der Zande
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rg-435-PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Obstetrics and Gynecology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mark R Johnson
- Department of Obstetric Medicine, Imperial College London, Kensington, London, UK
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49
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Editorial: Advances in cardiovascular medicine: debates and controversies. Curr Opin Anaesthesiol 2023; 36:1-4. [PMID: 36550600 DOI: 10.1097/aco.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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50
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Truong TH, Kim NT, Nguyen DP, Thi Nguyen MN, Do DL, Le TT, Le HA. Outcomes of pregnant women hospitalized with unrepaired congenital heart disease: Insights from a multidisciplinary center in Vietnam. Obstet Med 2023. [DOI: 10.1177/1753495x221148819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background In developing countries, fewer women have access to multidisciplinary congenital heart disease and reproductive programs staffed by experts. We report pregnancy outcomes of a multidisciplinary healthcare strategy utilizing an in-hospital teamwork approach in Vietnam. Methods This retrospective cohort study included pregnant women with unrepaired congenital heart disease managed at a referral cardiovascular center. Results Undiagnosed congenital heart disease before pregnancy, a lack of pre-pregnancy cardiology counseling, and modified World Health Organization class III/IV were common. Under the multispecialty healthcare strategy, although the rate of maternal death was 8.2% in the modified World Health Organization class IV group, no deaths occurred in any other group. Fetal/neonatal complications occurred in 54% of pregnancies, and 49.4% of neonates survived. Poor pregnancy outcomes were associated with admission during the first/seconde trimester for fetus/neonates, third trimester for mother, modified World Health Organization class III/IV, cyanosis, and heart failure. Conclusion The outcomes of pregnant women with unrepaired congenital heart disease were poor but seemed to improve with a multidisciplinary in-hospital healthcare teamwork strategy.
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Affiliation(s)
- Thanh-Huong Truong
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - Ngoc-Thanh Kim
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - Dinh-Phuc Nguyen
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - Mai-Ngoc Thi Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - Doan-Loi Do
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
| | - Thanh-Tung Le
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Hong-An Le
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
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