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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bodakçi E, Cansu DÜ, Korkmaz C. Poor obstetric outcomes in women with takayasu arteritis: a retrospective cohort study. Rheumatol Int 2024; 44:1111-1117. [PMID: 38363321 DOI: 10.1007/s00296-024-05538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/08/2024] [Indexed: 02/17/2024]
Abstract
The objective of this study was to assess the pregnancy outcomes in a cohort of patients who experienced pregnancies before and/or after being diagnosed with Takayasu's arteritis (TA). The present investigation encompassed a total of 88 pregnancies seen in a cohort of 35 patients who met the criteria outlined by the American College of Rheumatology in 1990 for the classification of Takayasu arteritis (TA). Pregnancies were classified into two categories. 1. Pregnancies that occurred before the diagnosis (pre-d or pre-TA) 2. Pregnancies that happened following a diagnosis (post-d or post-TA). Fifty-nine pregnancies (67.0%) occurred in 21 TA patients before the diagnosis with and a complication rate of 15.2%, and twenty-nine pregnancies (33.0%) occurred in 14 patients concomitant with or after TA diagnosis and complication rate 100%. Although the hypertension rate was higher in the pre-d group than in the post-d group, it was not significant (32.2% vs. 10.3%, p = 0.160). However, preeclampsia (20.6% vs. 0%, p = 0.001), low birth weight (27.5% vs. 1.6%, p = 0.001), and prematurity (24.1% vs. 1.6%, p = 0.035) were observed more frequently in the post-d group compared to the pre-d group. The frequency of abortions and in-utero deaths were similar in both groups (p > 0.05). Patients with hypertension had significantly higher rates of preeclampsia (p = 0.003), preterm birth (p = 0.036), low birth weight (p = 0.250), abortion (p = 0.018), in utero death (p = 0.128), and cesarean section (p = 0.005) than those without hypertension. Renal artery involvement was detected in 15 (42.8%) patients. All patients with renal artery involvement had hypertension, and they had significantly more pregnancy complications than the other group (p = 0.001). TA negatively affects pregnancy outcomes. A good control of arterial hypertension before conception and during pregnancy is critical to improve both maternal and fetal outcomes. In addition, detecting renal artery stenosis before pregnancy is important in reducing possible negative pregnancy outcomes.
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Affiliation(s)
- Erdal Bodakçi
- Division of Rheumatology, Department of Internal Medicine, Eskisehir State Hospıtal, Eskisehir, 26100, Turkey.
| | - Döndü Üsküdar Cansu
- Division of Rheumatology, Faculty of Medicine, Department of Internal Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey
| | - Cengiz Korkmaz
- Division of Rheumatology, Faculty of Medicine, Department of Internal Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey
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Choi WY, Park KT, Kim HM, Cho JH, Nam G, Hong J, Kang D, Lee J. Pregnancy related complications in women with hypertrophic cardiomyopathy: a nationwide population-based cohort study. BMC Cardiovasc Disord 2024; 24:268. [PMID: 38773383 DOI: 10.1186/s12872-024-03812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/23/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND The impact of hypertrophic cardiomyopathy (HCM) on cardiovascular and obstetrical outcomes in pregnant women remains unclear, particularly in Asian populations. This study aimed to evaluate the maternal cardiovascular and obstetrical outcomes in Korean women with HCM. METHODS Using data from the Korean National Health Insurance Service database, we identified women who gave birth via cesarean section or vaginal delivery after being diagnosed with HCM between 2006 and 2019. Maternal cardiovascular and obstetrical outcomes were assessed based on the trimester of pregnancy. RESULTS This study included 122 women and 158 pregnancies. No maternal deaths were noted; however, 21 cardiovascular events, such as hospital admission for cardiac problems, including heart failure and atrial fibrillation (AF), new-onset AF or ventricular tachycardia (VT) occurred in 14 pregnancies (8.8%). Cardiac events occurred throughout pregnancy with a higher occurrence in the third trimester. Cesarean sections were performed in 49.3% of the cases, and all cardiovascular outcomes occurring after delivery were observed in patients who had undergone cesarean sections. Seven cases involved preterm delivery, and two of these cases were accompanied by cardiac events, specifically AF. Pre-existing arrhythmia (AF: odds ratio (OR): 7.44, 95% confidence interval (CI): 2.61-21.21, P < 0.001; VT: OR: 31.61, 95% CI: 5.85-172.77, P < 0.001) was identified as a predictor for composite outcomes of cardiovascular events or preterm delivery. CONCLUSIONS Most pregnant women with HCM were well-tolerated. However, cardiovascular complications could occur in some patients. Therefore, planned delivery may be necessary for selected patients, especially the women with pre-existing arrhythmias.
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Affiliation(s)
- Won Yeol Choi
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 84 Heukseok ro, Dongjak-gu, Seoul, 06974, South Korea
| | - Kyung-Taek Park
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 84 Heukseok ro, Dongjak-gu, Seoul, 06974, South Korea
| | - Hyue Mee Kim
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 84 Heukseok ro, Dongjak-gu, Seoul, 06974, South Korea.
| | - Jun Hwan Cho
- Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gyeonggi, South Korea
| | - Gina Nam
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joonhwa Hong
- Department of Thoracic and Cardiovascular Surgery, Chung-Ang University Hospital, Chung- Ang University College of Medicine, Seoul, South Korea
| | - Dongwoo Kang
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Korea
| | - Jungkuk Lee
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Korea
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Zahid S, Mohamed MS, Rajendran A, Minhas AS, Khan MZ, Nazir NT, Ocon AJ, Weber BN, Isiadinso I, Michos ED. Rheumatoid arthritis and cardiovascular complications during delivery: a United States inpatient analysis. Eur Heart J 2024; 45:1524-1536. [PMID: 38427130 DOI: 10.1093/eurheartj/ehae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND AIMS Persons with rheumatoid arthritis (RA) have an increased risk of obstetric-associated complications, as well as long-term cardiovascular (CV) risk. Hence, the aim was to evaluate the association of RA with acute CV complications during delivery admissions. METHODS Data from the National Inpatient Sample (2004-2019) were queried utilizing ICD-9 or ICD-10 codes to identify delivery hospitalizations and a diagnosis of RA. RESULTS A total of 12 789 722 delivery hospitalizations were identified, of which 0.1% were among persons with RA (n = 11 979). Individuals with RA, vs. those without, were older (median 31 vs. 28 years, P < .01) and had a higher prevalence of chronic hypertension, chronic diabetes, gestational diabetes mellitus, obesity, and dyslipidaemia (P < .01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, RA remained an independent risk factor for peripartum CV complications including preeclampsia [adjusted odds ratio (aOR) 1.37 (95% confidence interval 1.27-1.47)], peripartum cardiomyopathy [aOR 2.10 (1.11-3.99)], and arrhythmias [aOR 2.00 (1.68-2.38)] compared with no RA. Likewise, the risk of acute kidney injury and venous thromboembolism was higher with RA. An overall increasing trend of obesity, gestational diabetes mellitus, and acute CV complications was also observed among individuals with RA from 2004-2019. For resource utilization, length of stay and cost of hospitalization were higher for deliveries among persons with RA. CONCLUSIONS Pregnant persons with RA had higher risk of preeclampsia, peripartum cardiomyopathy, arrhythmias, acute kidney injury, and venous thromboembolism during delivery hospitalizations. Furthermore, cardiometabolic risk factors among pregnant individuals with RA rose over this 15-year period.
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Affiliation(s)
- Salman Zahid
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Mohamed S Mohamed
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Aardra Rajendran
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Anum S Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Muhammad Zia Khan
- Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
| | - Noreen T Nazir
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Anthony J Ocon
- Division of Allergy, Immunology & Rheumatology, Rochester Regional Health, Rochester, NY, USA
| | - Brittany N Weber
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ijeoma Isiadinso
- Division of Cardiology, Center for Heart Disease Prevention, Emory University School of Medicine, Atlanta, GA, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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McGourty M, Skaritanov E, Kovell L, Wilkie G. Cardiac evaluation in pregnant patients with dyspnea and palpitations. Am J Obstet Gynecol MFM 2024; 6:101359. [PMID: 38552959 DOI: 10.1016/j.ajogmf.2024.101359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Symptoms of underlying cardiac disease in pregnancy can often be mistaken for common complaints because of normal physiological changes in pregnancy. Echocardiographic evaluation of patients with symptoms of palpitations and dyspnea can detect structural changes and identify high-risk features. OBJECTIVE This study aimed to examine transthoracic echocardiograms of perinatal individuals completed for palpitations or dyspnea to determine the frequency of identifying structural changes. STUDY DESIGN This was a retrospective cohort study of all perinatal individuals with a transthoracic echocardiogram at a single academic center between October 1, 2017, and May 1, 2022. The indication for the echocardiogram, demographics, and clinical characteristics were recorded. Transthoracic echocardiograms with any abnormal findings noted in the transthoracic echocardiogram report were reviewed and categorized into findings of congenital heart disease, valvular disease, pericardial effusion, evidence of ischemia or wall motion abnormalities, abnormal diastolic or systolic function, and other. RESULTS Of 539 transthoracic echocardiograms completed on 478 individuals who were pregnant or in the 12-week postpartum period, 96 (17.8%) had an indication of palpitations, and 32 (5.9%) had an indication of dyspnea. Abnormal findings were seen in 21.9% of patients with palpitations and in 34.4% of patients with dyspnea. In patients with palpitations who had abnormal findings, 33.3% had congenital heart disease; 33.3% had mild valvular disease, including mitral valve prolapse; 19.0% had a pericardial effusion; and 14.3% had evidence of ischemia or wall motion defects. Abnormal transthoracic echocardiogram findings in the dyspnea cohort included ischemia or wall motion defects (27.3%), mild valvular disease or mitral valve prolapse (36.4%), and abnormal systolic or diastolic function (36.4%). CONCLUSION Many of the transthoracic echocardiograms completed for patients with dyspnea or palpitations identified no structural abnormality; however, in 1 of 3 to 1 of 4 patients, underlying structural heart disease was identified. Although some of these abnormalities were unlikely to change delivery plans, such as mild valvular disease or small effusions, other abnormalities, such as ischemia, congenital abnormalities, and abnormal systolic or diastolic function, were likely to have implications for pregnancy and postpartum management.
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MESH Headings
- Humans
- Female
- Pregnancy
- Dyspnea/diagnosis
- Dyspnea/physiopathology
- Dyspnea/etiology
- Dyspnea/epidemiology
- Retrospective Studies
- Adult
- Echocardiography/methods
- Echocardiography/statistics & numerical data
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/epidemiology
- Pericardial Effusion/diagnosis
- Pericardial Effusion/physiopathology
- Pericardial Effusion/epidemiology
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/epidemiology
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/epidemiology
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/physiopathology
- Heart Valve Diseases/epidemiology
- Heart Valve Diseases/complications
- Heart Diseases/diagnosis
- Heart Diseases/physiopathology
- Heart Diseases/epidemiology
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Affiliation(s)
- Marie McGourty
- University of Massachusetts Chan School of Medicine, Worcester, MA (BS McGourty and BS Skaritanov)
| | - Ekaterina Skaritanov
- University of Massachusetts Chan School of Medicine, Worcester, MA (BS McGourty and BS Skaritanov)
| | - Lara Kovell
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Chan School of Medicine, Worcester, MA (Dr Kovell)
| | - Gianna Wilkie
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Chan School of Medicine, Worcester, MA (Dr Wilkie).
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Safira A, Tjahjadi AK, Adytia GJ, Waitupu A, Sutanto H. Peripartum cardiomyopathy unveiled: Etiology, diagnosis, and therapeutic insights. Curr Probl Cardiol 2024; 49:102474. [PMID: 38395115 DOI: 10.1016/j.cpcardiol.2024.102474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
Peripartum cardiomyopathy (PPCM) remains a significant challenge in maternal health, marked by its unpredictable onset and varied clinical outcomes. With rising incidence rates globally, understanding PPCM is vital for improving maternal care and prognosis. This review aims to consolidate current knowledge on PPCM, highlighting recent advancements in its diagnosis, management, and therapeutic approaches. This comprehensive review delves into the epidemiology of PPCM, underscoring its global impact and demographic variations. We explore the complex etiology of the condition, examining known risk factors and discussing the potential pathophysiological mechanisms, including oxidative stress and hormonal influences. The clinical presentation of PPCM, often similar yet distinct from other forms of cardiomyopathy, is analyzed to aid in differential diagnosis. Diagnostic challenges are addressed, emphasizing the role of advanced imaging and biomarkers. Current management strategies are reviewed, focusing on the absence of disease-specific treatments and the application of general heart failure protocols. The review also discusses the prognosis of PPCM, factors influencing recovery, and the implications for future pregnancies. Finally, we highlight emerging research directions and the urgent need for disease-specific therapies, aiming to provide a roadmap for future studies and improved patient care. This review serves as a crucial resource for clinicians and researchers, contributing to a deeper understanding and better management of PPCM.
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Affiliation(s)
- Ardea Safira
- Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Angela Kimberly Tjahjadi
- Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Galih Januar Adytia
- Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Alief Waitupu
- Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Henry Sutanto
- Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
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Qureshi N, Kontorovich A, Veledar E, Tlachi P, Feltovich H, Mancini DM, Barghash M, Stone J, Bianco A, Shaw LJ, Lala A. Frequency and Clinical Implications of Referrals to Heart Failure Among Patients with Peripartum Cardiomyopathy. J Card Fail 2024; 30:717-721. [PMID: 38158153 DOI: 10.1016/j.cardfail.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/10/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but significant cause of new-onset heart failure (HF) during the peri- and post-partum periods. Advances in GDMT for HF with reduced ventricular function have led to substantial improvements in survival and quality of life, yet few studies examine the longitudinal care received by patients with PPCM. The aim of this research is to address this gap by retrospectively characterizing patients with PPCM across a multihospital health system and investigating the frequency of cardiology and HF specialty referrals. Understanding whether surveillance and medical management differ among patients referred to HF will help to underscore the importance of referring patients with PPCM to HF specialists for optimal care.
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Affiliation(s)
- Natasha Qureshi
- Department of Medicine, Mount Sinai Beth Israel, New York, New York
| | - Amy Kontorovich
- Department of Medicine, Division of Cardiology, Cardiovascular Research Institute, Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emir Veledar
- Department of Biostatistics at Robert Stempel College of Public Health Florida International University, Miami, Florida; Department of Cardiology, Emory University, School of Medicine, Atlanta, Georgia
| | - Pilar Tlachi
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Helen Feltovich
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Donna M Mancini
- Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maya Barghash
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joanne Stone
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Angela Bianco
- The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leslee J Shaw
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
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Fishel Bartal M, Chen HY, Amro F, Mendez-Figueroa H, Wagner SM, Sibai BM, Chauhan SP. Racial and Ethnic Disparities among Pregnancies with Chronic Hypertension and Adverse Outcomes. Am J Perinatol 2024; 41:e1145-e1155. [PMID: 36528021 DOI: 10.1055/a-2000-6289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We aimed to ascertain whether the risk of adverse pregnancy outcomes in the United States among individuals with chronic hypertension differed by maternal race and ethnicity and to assess the temporal trend. STUDY DESIGN Population-based retrospective study using the U.S. Vital Statistics datasets evaluated pregnancies with chronic hypertension, singleton live births that delivered at 24 to 41 weeks. The coprimary outcomes were a composite maternal adverse outcome (preeclampsia, primary cesarean delivery, intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy) and a composite neonatal adverse outcome (preterm birth, small for gestational age, Apgar's score <5 at 5 minutes, assisted ventilation> 6 hours, seizure, or death). Multivariable Poisson regression models were used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs). RESULTS Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased from 1.6 to 2.2%. After multivariable adjustment, an increased risk for the composite maternal adverse outcome was found in Black (aRR = 1.10, 95% CI = 1.09-1.11), Hispanic (aRR = 1.04, 95% CI = 1.02-1.05), and Asian/Pacific Islander (aRR = 1.07, 95% CI = 1.05-1.10), compared with White individuals. Compared with White individuals, the risk of the composite neonatal adverse outcome was higher in Black (aRR = 1.39, 95% CI = 1.37-1.41), Hispanic (aRR = 1.15, 95% CI = 1.13-1.16), Asian/Pacific Islander (aRR = 1.34, 95% CI = 1.31-1.37), and American Indian (aRR = 1.12, 95% CI = 1.07-1.17). The racial and ethnic disparity remained unchanged during the study period. CONCLUSION We found a racial and ethnic disparity with maternal and neonatal adverse outcomes in pregnancies with chronic hypertension that remained unchanged throughout the study period. KEY POINTS · Between 2014 and 2019, the rate of chronic hypertension in pregnancy increased.. · Among people with chronic hypertension, there are racial and ethnic disparities in adverse outcomes.. · Black, Hispanic, and Asian/Pacific Islander have a higher risk of the adverse neonatal outcomes..
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Affiliation(s)
- Michal Fishel Bartal
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
- Department of Obstetrics and Gynecology, Sheba Medical Center at Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Han-Yang Chen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Farah Amro
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Hector Mendez-Figueroa
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Stephen M Wagner
- Department of Obstetrics and Gynecology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Suneet P Chauhan
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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Ishikuro M, Obara T, Murakami K, Ueno F, Noda A, Onuma T, Kikuya M, Metoki H, Kuriyama S. The association between blood pressure control in women during pregnancy and adverse perinatal outcomes: the TMM BirThree Cohort Study. Hypertens Res 2024; 47:1216-1222. [PMID: 38238512 PMCID: PMC11073994 DOI: 10.1038/s41440-023-01570-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 12/07/2023] [Accepted: 12/16/2023] [Indexed: 05/08/2024]
Abstract
Blood pressure (BP) control in pregnancy is essential to prevent adverse outcomes. However, BP levels for hypertension treatment are inconsistent among various guidelines. This study investigated the association between BP control and adverse perinatal outcomes. A total of 18,155 mother-offspring pairs were classified into four groups according to BP after 20 gestational weeks: normal BP (<140/90 mmHg without antihypertensive drugs), high BP (≥140/90 mmHg without antihypertensive drugs), controlled BP (<140/90 mmHg with antihypertensive drugs), and uncontrolled BP (≥140/90 mmHg with antihypertensive drugs). The prevalence of small for gestational age was 1,087/17,476 offspring in normal BP, 78/604 in high BP, 5/42 in controlled BP, and 7/33 in uncontrolled BP. Compared to normal BP, adjusted odds ratios (ORs) (95% confidence intervals (CIs)) were 1.76 (1.32-2.35) for high BP, 2.08 (0.79-5.50) for controlled BP, and 2.34 (0.94-5.85) for uncontrolled BP (multiple logistic regression analysis). Similarly, the adjusted ORs (95% CIs) were 1.80 (1.35-2.41), 3.42 (1.35-8.63), and 5.10 (1.93-13.45) for high, controlled, and uncontrolled BPs for low birth weight, respectively; 1.99 (1.48-2.68), 2.70 (1.12-6.50), and 6.53 (3.09-13.82) for high, controlled, and uncontrolled BPs for preterm birth, respectively; 1.64 (1.19-2.24), 2.17 (0.88-5.38), and 2.12 (0.80-5.65) for high, controlled, and uncontrolled BPs for admission to the Neonatal Intensive Care Unit or Growing Care Unit, respectively; and 1.17 (0.70-1.95), 2.23 (0.65-7.68), and 0.91 (0.20-4.16) for high, controlled, and uncontrolled BPs for 1-min Apgar score < 7, respectively. BP ≥ 140/90 mmHg might be taken care for preventing various adverse perinatal outcomes.
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Affiliation(s)
- Mami Ishikuro
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan.
- Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan
- Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
- Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Keiko Murakami
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan
- Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Fumihiko Ueno
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan
- Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Aoi Noda
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan
- Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
- Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tomomi Onuma
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan
| | - Masahiro Kikuya
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan
- Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Hirohito Metoki
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan
- Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1, Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8536, Japan
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan
- Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
- International Research Institute of Disaster Science, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8573, Japan
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10
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Zhang DW, Zhu YB, Zhou SJ, Chen XH, Li HB, Liu WJ, Wu ZQ, Chen Q, Cao H. Maternal cardiovascular health in early pregnancy and the risk of congenital heart defects in offspring. BMC Pregnancy Childbirth 2024; 24:325. [PMID: 38671408 PMCID: PMC11047036 DOI: 10.1186/s12884-024-06529-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is the predominant birth defect. This study aimed to explore the association between maternal cardiovascular health (CVH) and the CHD risk in offspring. METHODS We used the prospective data from the Fujian Birth Cohort Study, collected from March 2019 to December 2022 on pregnant women within 14 weeks of gestation. Overall maternal CVH was assessed by seven CVH metrics (including physical activity, smoking, sleep duration, body mass index, blood pressure, total cholesterol, and fasting plasma glucose), with each metric classified as ideal, intermediate or poor with specific points. Participants were further allocated into high, moderate and low CVH categories based on the cumulative CVH score. The association with offspring CHD was determined with log-binominal regression models. RESULTS A total of 19810 participants aged 29.7 (SD: 3.9) years were included, with 7846 (39.6%) classified as having high CVH, 10949 (55.3%) as having moderate CVH, and 1015 (5.1%) as having low CVH. The average offspring CHD rate was 2.52%, with rates of 2.35%, 2.52% and 3.84% across the high, moderate and low CVH categories, respectively (P = 0.02). Adjusted relative risks (RRs) of having offspring CHD were 0.64 (95% CI: 0.45-0.90, P = 0.001) for high CVH and 0.67 (95% CI: 0.48-0.93, P = 0.02) for moderate CVH compared to low CVH. For individual metrics, only ideal total cholesterol was significantly associated with lower offspring CHD (RR: 0.73, 95% CI: 0.59-0.83, P = 0.002). CONCLUSIONS Pregnant women of high or moderate CVH categories in early pregnancy had reduced risks of CHD in offspring, compared to those of low CVH. It is important to monitor and improve CVH during pre-pregnancy counseling and early prenatal care.
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Affiliation(s)
- Dan-Wei Zhang
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.966 Hengyu Road, Jinan District, Fuzhou, 350014, People's Republic of China
| | - Yi-Bing Zhu
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People's Republic of China
| | - Si-Jia Zhou
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.966 Hengyu Road, Jinan District, Fuzhou, 350014, People's Republic of China
| | - Xiu-Hua Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.966 Hengyu Road, Jinan District, Fuzhou, 350014, People's Republic of China
| | - Hai-Bo Li
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People's Republic of China
| | - Wen-Juan Liu
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People's Republic of China
- Division of Birth Cohort Study, Fujian Children's Hospital, Fuzhou, People's Republic of China
| | - Zheng-Qin Wu
- Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People's Republic of China
- Division of Birth Cohort Study, Fujian Obstetrics and Gynecology Hospital, Fuzhou, People's Republic of China
| | - Qiang Chen
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.966 Hengyu Road, Jinan District, Fuzhou, 350014, People's Republic of China.
| | - Hua Cao
- Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.966 Hengyu Road, Jinan District, Fuzhou, 350014, People's Republic of China.
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Laird AC, Kumnick AR, Fries MH, Chornock RL. Obstetrical and neonatal outcomes in patients with surgically repaired heart disease. Am J Obstet Gynecol MFM 2024; 6:101323. [PMID: 38438010 DOI: 10.1016/j.ajogmf.2024.101323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Congenital and acquired heart disease complicate 1% to 4% of pregnancies in the United States. Beyond the risks of the underlying maternal congenital heart disease, cardiac surgery and its sequelae, such as surgical scarring resulting in higher rates of arrhythmias and implanted valves altering anticoagulation status, have potential implications that could affect gestation and delivery. OBJECTIVE This study aimed to investigate whether history of maternal cardiac surgery is associated with adverse obstetrical or neonatal outcomes compared with patients without a history of cardiac disease or surgery, considered "healthy controls." STUDY DESIGN This is a secondary analysis of retrospective cohort studies performed at a tertiary care facility in the United States comparing obstetrical outcomes in patients with a history of open cardiac surgery who delivered from January 2007 to December 2018 with healthy controls, who delivered from April 2020 to July 2020. There were 74 pregnancies in 61 patients with a history of open cardiac surgery that were compared with pregnancies in healthy controls. Of the 74 pregnancies, 65 were successfully matched based on gestational age to controls at a 1:3 (case-to-control) ratio. The remainder of cases were matched at a 1:2 or 1:1 ratio; therefore, a total of 219 control pregnancies were included in the analysis. Our primary outcome was the incidence of hypertensive disorders of pregnancy, as well as cesarean delivery, in patients with a history of open cardiac surgery compared with healthy controls. Our secondary outcome was the incidence of low-birthweight neonates in patients with a history of open cardiac surgery compared with healthy controls. RESULTS Patients with a history of cardiac surgery were not more likely to have any hypertensive disorder diagnosed than healthy controls. Patients with a history of cardiac surgery were more likely to have an operative delivery (P<.0001) but equally likely to have a cesarean delivery (P=.528) compared with healthy controls. Birthweight was not statistically different of 2655±808 g in neonates born to patients with a history of cardiac surgery vs 2844±830 g born to healthy controls (P=.092). CONCLUSION Patients with a history of cardiac surgery may not be at higher risk of hypertensive disorder diagnosis during pregnancy. Similarly, most patients with a history of cardiac surgery are also likely not at higher risk of cesarean delivery or low-birthweight neonates.
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Affiliation(s)
- Anne C Laird
- Georgetown University School of Medicine, Washington, DC (Ms Laird)
| | - Allison R Kumnick
- Division of Maternal Fetal Medicine, Department of Women's and Infant's Services, Medstar Washington Hospital Center, Washington, DC (Drs Kumnick, Fries, and Chornock)
| | - Melissa H Fries
- Division of Maternal Fetal Medicine, Department of Women's and Infant's Services, Medstar Washington Hospital Center, Washington, DC (Drs Kumnick, Fries, and Chornock)
| | - Rebecca L Chornock
- Division of Maternal Fetal Medicine, Department of Women's and Infant's Services, Medstar Washington Hospital Center, Washington, DC (Drs Kumnick, Fries, and Chornock).
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13
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Dhital R, Baer RJ, Bandoli G, Guma M, Poudel DR, Kalunian K, Weisman MH, Chambers C. Maternal cardiovascular events in autoimmune rheumatic diseases and antiphospholipid syndrome pregnancies. Am J Obstet Gynecol MFM 2024; 6:101319. [PMID: 38428526 DOI: 10.1016/j.ajogmf.2024.101319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Affiliation(s)
- Rashmi Dhital
- Division of Rheumatology, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0656.
| | - Rebecca J Baer
- Division of Environmental Science and Health, Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA; The California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA
| | - Gretchen Bandoli
- Division of Environmental Science and Health, Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
| | - Monica Guma
- Division of Rheumatology, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA; Department of Rheumatology, Veteran Affairs San Diego Healthcare System, San Diego, CA
| | - Dilli R Poudel
- Department of Medicine, Indiana Regional Medical Center, Indiana, PA
| | - Kenneth Kalunian
- Division of Rheumatology, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA
| | - Michael H Weisman
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA
| | - Christina Chambers
- Division of Environmental Science and Health, Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Whelan AR, Thorsen MM, MacCarrick G, Russo ML. Cardiovascular and obstetrical outcomes among delivering patients with Marfan or Loeys-Dietz syndrome: a retrospective analysis by hospital delivery setting. Am J Obstet Gynecol MFM 2024; 6:101340. [PMID: 38460826 DOI: 10.1016/j.ajogmf.2024.101340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Pregnancy is a high-risk time for patients with Marfan syndrome or Loeys-Dietz syndrome because of the risk for cardiovascular complications, including the risk for aortic dissection. Little is known about the differences in obstetrical and cardiac outcomes based on delivery hospital setting (academic or academic-affiliated vs community medical centers). OBJECTIVE This study aimed to evaluate the obstetrical and cardiac outcomes of patients with Marfan syndrome or Loeys-Dietz syndrome based on delivery hospital setting. STUDY DESIGN This was a secondary analysis of a retrospective, observational cohort study of singleton pregnancies among patients with a diagnosis of Marfan syndrome or Loeys-Dietz syndrome from 1990 to 2016. Patients were identified through the Marfan Foundation, the Loeys-Dietz Syndrome Foundation, or the Cardiovascular Connective Tissue Clinic at Johns Hopkins Hospital. Data were obtained via self-reported obstetrical history and verified by review of medical records. Nonparametric analyses were performed using Fisher's exact tests and Wilcoxon rank-sum tests. RESULTS A total of 273 deliveries among patients with Marfan syndrome or Loeys-Dietz syndrome were included in this analysis (Table 1). More patients who had a known diagnosis before delivery of either Marfan syndrome or Loeys-Dietz syndrome delivered at an academic hospital as opposed to a community hospital (78.6% vs 59.9%; P=.001). Patients with Marfan syndrome or Loeys-Dietz syndrome who delivered at academic centers were more likely to have an operative vaginal delivery than those who delivered at community centers (23.7% vs 8.6%; P=.002). When the indications for cesarean delivery were assessed, connective tissue disease was the primary indication for the mode of delivery at community centers when compared with academic centers (55.6% vs 43.5%; P=.02). There were higher rates of cesarean delivery for arrest of labor and/or malpresentation at community hospitals than at academic centers (23.6% vs 5.3%; P=.01). There were no differences between groups in terms of the method of anesthesia used for delivery. Among those with a known diagnosis of Marfan syndrome or Loeys-Dietz syndrome before delivery, there were increased operative vaginal delivery rates at academic hospitals than at community hospitals (27.2% vs 15.1%; P=.03) (Table 2). More patients with an aortic root measuring ≥4 cm before or after pregnancy delivered at academic centers as opposed to community centers (33.0% vs 10.2%; P=.01), but there were no significant differences in the median size of the aortic root during pregnancy or during the postpartum assessment between delivery locations. Cardiovascular complications were rare; 8 patients who delivered at academic centers and 7 patients who delivered at community centers had an aortic dissection either in pregnancy or the postpartum period (P=.79). CONCLUSION Patients with Marfan syndrome or Loeys-Dietz syndrome and more severe aortic phenotypes were more likely to deliver at academic hospitals. Those who delivered at academic hospitals had higher rates of operative vaginal delivery. Despite lower frequencies of aortic root diameter >4.0 cm, those who delivered at community hospitals had higher rates of cesarean delivery for the indication of Marfan syndrome or Loeys-Dietz syndrome. Optimal delivery management of these patients requires further prospective research.
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Affiliation(s)
- Anna R Whelan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Medical School; Worcester, MA (Dr. Whelan)
| | - Margaret M Thorsen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI (Drs. Thorsen, and Russo).
| | - Gretchen MacCarrick
- Department of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD (Ms MacCarrick)
| | - Melissa L Russo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital, Providence, RI (Drs. Thorsen, and Russo)
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16
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Collins IC, Blanchard CT, Tipre M, Oben A, Robinson A, Kako T, Joly JM, Cribbs MG, Casey B, Tita A, Sinkey R. Breastfeeding Practices in Patients with Heart Disease Stratified by Area Deprivation Index. Breastfeed Med 2024; 19:256-261. [PMID: 38502815 DOI: 10.1089/bfm.2023.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Objective: We sought to evaluate breastfeeding (BF) practices in patients with maternal cardiac disease (MCD) stratified by area deprivation index (ADI) to identity communities at risk. Study Design: Retrospective cohort of patients managed by the University of Alabama at Birmingham (UAB) Cardio-Obstetrics Program. Patients were included if they had ≥1 prenatal visit with the Cardio-Obstetrics team, delivered at UAB, and had a street address on file. The primary outcome was BF rate at hospital discharge. Secondary outcomes included BF intent on admission and BF at the postpartum (PP) visit. ADI reports socioeconomic disadvantage at the census tract level; 1 = least deprived and 100 = most deprived. Baseline characteristics and BF rates were compared by ADI categories: Low (ADI 1-33), medium (ADI 34-66), and high (ADI 67-100). Results: One hundred and forty-eight patients were included: 14 (10%) low, 42 (28%) medium, and 92 (62%) high ADI. Patients in the high ADI category were younger relative to those in the medium or low ADI (26 versus 28 versus 32 years; p < 0.01) and less likely to be married or living with a partner (30.4% versus 58.5% versus 71.4%; p < 0.01), There was no difference in BF intent between the lowest, medium, and highest ADI categories (85.7% versus 85.4% versus 81.6%; p = 0.38) or BF rates at hospital discharge (100% versus 92.7% versus 85.6%, p = 0.23). However, there was a significant difference in BF rates at the PP visit (90% versus 63.0% versus 38.6%; p < 0.01) even after controlling for differences in baseline characteristics (odds ratio = 0.11 (95% confidence interval [0.01-0.93]), p = 0.043). Conclusions: There was an association between living in a resource-poor community and early cessation of BF in our population of patients with MCD. Community-based interventions targeting mothers with heart disease living in high ADI communities may help these individuals achieve higher BF rates.
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Affiliation(s)
- Isabel C Collins
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Meghan Tipre
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ayamo Oben
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Ashton Robinson
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tavonna Kako
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Joanna M Joly
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Marc G Cribbs
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Brian Casey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Alan Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Rachel Sinkey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
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17
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Hart WM, Cobb B, Quist-Nelson J, Tully KP. Development and implementation of a pregnancy heart team at a Southeastern United States tertiary hospital: a qualitative study. Am J Obstet Gynecol MFM 2024; 6:101336. [PMID: 38453018 DOI: 10.1016/j.ajogmf.2024.101336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The United States has seen a significant rise in maternal mortality and morbidity associated with cardiovascular disease over the past 4 decades. Contributing factors may include an increasing number of parturients with comorbid conditions, a higher rate of pregnancy among women of advanced maternal age, and more patients with congenital heart disease who survive into childbearing age and experiencing pregnancy. In response, national medical organizations have recommended the creation of multidisciplinary obstetric-cardiac teams, also known as pregnancy heart teams, to provide comprehensive preconception counseling and coordinated pregnancy management that extend through the postpartum period. OBJECTIVE We sought to describe the development and implementation of a pregnancy heart team for parturients with cardiac disease at a southeastern United States tertiary hospital. STUDY DESIGN This was a qualitative study that was conducted among healthcare team members involved during the pregnancy heart team formation. Semi-structured interviews were conducted between April and May 2022, professionally transcribed, and the responses were thematically coded for categories and themes using constructs from The Consolidated Framework for Implementation Research. RESULTS Themes identified included intentional collaboration to improve outpatient and inpatient coordination through earlier awareness of patients who meet the criteria and via documented care planning. The pregnancy heart team united clinicians around best practices and coordination to promote the success and safety of pregnancies and not only to minimize maternal health risks. Developing longitudinal care plans was critical among the pathway team to build on collective expertise and to provide clarity for those on shift to reduce hesitancy and achieve timely, vetted practices without additional consults. Establishing a proactive approach of specialists offering their perspectives was viewed as positively contributing to a culture of speaking up. Barriers to the successful development and sustainability of the pregnancy heart team included unmet administrative needs and clinician turnover within a context of shortages in staffing and high workload. CONCLUSION This study described the process of developing and implementing a pregnancy heart team at 1 institution, thereby offering insights for future multidisciplinary care for maternal cardiac patients. Establishing pregnancy heart teams can enhance quality care for high-risk patients, foster learning and collaboration among physician and nursing specialties, and improve coordination to manage complex maternal cardiac cases.
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Affiliation(s)
- William Michael Hart
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Hart and Cobb).
| | - Ben Cobb
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Hart and Cobb)
| | - Johanna Quist-Nelson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Quist-Nelson and Tully)
| | - Kristin P Tully
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Drs Quist-Nelson and Tully)
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18
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Rajpal S, Rodriguez CP. High-Risk Congenital Heart Disease in Pregnancy. Methodist Debakey Cardiovasc J 2024; 20:24-35. [PMID: 38495662 PMCID: PMC10941697 DOI: 10.14797/mdcvj.1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/03/2024] [Indexed: 03/19/2024] Open
Abstract
High-risk congenital heart disease (CHD) in pregnancy presents a complex clinical challenge. With improved medical care and increased survival rates, a growing population of adults with complex CHD are surviving to adulthood, including women of reproductive age. This chapter focuses on risk stratification and management of pregnant women with high-risk CHD, emphasizing the importance of considering both anatomical and physiological complexity. Maternal physiological changes, such as blood volume increase, cardiac output changes, and alterations in vascular resistance, can significantly impact high-risk CHD patients. Management of high-risk CHD in pregnancy necessitates a multidisciplinary approach and individualized care.
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Affiliation(s)
- Saurabh Rajpal
- The Ohio State University Wexner Medical Center, Columbus, Ohio, US
- Nationwide Children’s Hospital, Columbus, Ohio, US
| | - Carla P. Rodriguez
- Nationwide Children’s Hospital, Columbus, Ohio, US
- Boston Children’s Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, US
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19
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Ananth CV, Lee R, Valeri L, Ross Z, Graham HL, Khan S, Cabrera J, Rosen T, Kostis WJ. Placental Abruption and Cardiovascular Event Risk (PACER): Design, data linkage, and preliminary findings. Paediatr Perinat Epidemiol 2024; 38:271-286. [PMID: 38273776 PMCID: PMC10978269 DOI: 10.1111/ppe.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Obstetrical complications impact the health of mothers and offspring along the life course, resulting in an increased burden of chronic diseases. One specific complication is abruption, a life-threatening condition with consequences for cardiovascular health that remains poorly studied. OBJECTIVES To describe the design and data linkage algorithms for the Placental Abruption and Cardiovascular Event Risk (PACER) cohort. POPULATION All subjects who delivered in New Jersey, USA, between 1993 and 2020. DESIGN Retrospective, population-based, birth cohort study. METHODS We linked the vital records data of foetal deaths and live births to delivery and all subsequent hospitalisations along the life course for birthing persons and newborns. The linkage was based on a probabilistic record-matching algorithm. PRELIMINARY RESULTS Over the 28 years of follow-up, we identified 1,877,824 birthing persons with 3,093,241 deliveries (1.1%, n = 33,058 abruption prevalence). The linkage rates for live births-hospitalisations and foetal deaths-hospitalisations were 92.4% (n = 2,842,012) and 70.7% (n = 13,796), respectively, for the maternal cohort. The corresponding linkage rate for the live births-hospitalisations for the offspring cohort was 70.3% (n = 2,160,736). The median (interquartile range) follow-up for the maternal and offspring cohorts was 15.4 (8.1, 22.4) and 14.4 (7.4, 21.0) years, respectively. We will undertake multiple imputations for missing data and develop inverse probability weights to account for selection bias owing to unlinked records. CONCLUSIONS Pregnancy offers a unique window to study chronic diseases along the life course and efforts to identify the aetiology of abruption may provide important insights into the causes of future CVD. This project presents an unprecedented opportunity to understand how abruption may predispose women and their offspring to develop CVD complications and chronic conditions later in life.
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Affiliation(s)
- Cande V. Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Rachel Lee
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Linda Valeri
- Department of Biostatistics, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Inc., Ithaca, NY, USA
| | - Hillary L. Graham
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Clinical Epidemiology Division, Faculty of Medicine at Solna, Karolinska Institutet, Stockholm, Sweden
| | - Shama Khan
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Javier Cabrera
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Statistics, Rutgers University, Piscataway, NJ, USA
| | - Todd Rosen
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William J. Kostis
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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20
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Ejim EC, Karaye KM, Antia S, Isiguzo GC, Njoku PO. Peripartum cardiomyopathy in low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 93:102476. [PMID: 38395024 DOI: 10.1016/j.bpobgyn.2024.102476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/15/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Peripartum cardiomyopathy (PPCM) causes pregnancy-associated heart failure, typically during the last month of pregnancy, and up to 6 months post-partum, in women without known cardiovascular disease. PPCM is a global disease, but with a significant geographical variability within and between countries. Its true incidence in Africa is still unknown because of the lack of a PPCM population-based study. The variability in the epidemiology of PPCM between and within countries could be due to differences in the prevalence of both genetic and non-genetic risk factors. Several risk factors have been implicated in the aetiopathogenesis of PPCM over the years. Majority of patients with PPCM present with symptoms and signs of congestive cardiac failure. Diagnostic work up in PPCM is prompted by strong clinical suspicion, but Echocardiography is the main imaging technique for diagnosis. The management of PPCM involves multiple disciplines - cardiologists, anaesthetists, intensivists, obstetricians, neonatologists, and the prognosis varies widely.
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Affiliation(s)
- Emmanuel C Ejim
- Department of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria.
| | - Kamilu M Karaye
- Bayero University & Aminu Kano Teaching Hospital Kano, Nigeria.
| | - Samuel Antia
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Godsent C Isiguzo
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Paschal O Njoku
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
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21
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Sliwa K, van der Meer P, Viljoen C, Jackson AM, Petrie MC, Mebazaa A, Hilfiker-Kleiner D, Maggioni AP, Laroche C, Regitz-Zagrosek V, Tavazzi L, Roos-Hesselink JW, Hamdan R, Frogoudaki A, Ibrahim B, Farhan HAF, Mbakwem A, Seferovic P, Böhm M, Pieske B, Johnson MR, Bauersachs J. Socio-economic factors determine maternal and neonatal outcomes in women with peripartum cardiomyopathy: A study of the ESC EORP PPCM registry. Int J Cardiol 2024; 398:131596. [PMID: 37979788 DOI: 10.1016/j.ijcard.2023.131596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/20/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a global disease with substantial morbidity and mortality. The aim of this study was to analyze to what extent socioeconomic factors were associated with maternal and neonatal outcomes. METHODS In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global PPCM registry, under the auspices of the ESC EORP Programme. We investigated the characteristics and outcomes of women with PPCM and their babies according to individual and country-level sociodemographic factors (Gini index coefficient [GINI index], health expenditure [HE] and human developmental index [HDI]). RESULTS 739 women from 49 countries (Europe [33%], Africa [29%], Asia-Pacific [15%], Middle East [22%]) were enrolled. Low HDI was associated with greater left ventricular (LV) dilatation at time of diagnosis. However, baseline LV ejection fraction did not differ according to sociodemographic factors. Countries with low HE prescribed guideline-directed heart failure therapy less frequently. Six-month mortality was higher in countries with low HE; and LV non-recovery in those with low HDI, low HE and lower levels of education. Maternal outcome (death, re-hospitalization, or persistent LV dysfunction) was independently associated with income. Neonatal death was significantly more common in countries with low HE and low HDI, but was not influenced by maternal income or education attainment. CONCLUSIONS Maternal and neonatal outcomes depend on country-specific socioeconomic characteristics. Attempts should therefore be made to allocate adequate resources to health and education, to improve maternal and fetal outcomes in PPCM.
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Affiliation(s)
- Karen Sliwa
- Cape Heart Institute, Department of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Charle Viljoen
- Cape Heart Institute, Department of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alice M Jackson
- Institute of Cardiovascular and Medical Sciences, Glasgow University, Glasgow, United Kingdom
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, Glasgow University, Glasgow, United Kingdom
| | - Alexandre Mebazaa
- Department of Anaesthesia and Critical Care, University Hospitals Saint Louis-Lariboisière Paris, University Paris Diderot, Paris, France
| | | | - Aldo P Maggioni
- ANMCO Research Centre, Firenze, Italy; EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France
| | - Cecile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France
| | - Vera Regitz-Zagrosek
- Berlin Institute of Gender in Medicine (GiM), Charité - Universitätsmedizin, Berlin, Germany
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | | | - Righab Hamdan
- Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | | | | | - Hasan Ali Farhan Farhan
- Iraqi Board for Medical Specializations, Scientific Council of Cardiology, College of Medicine, University of Baghdad, Baghdad Heart Center, Baghdad, Iraq
| | - Amam Mbakwem
- Department of Medicine, College of Medicine and Lagos University Teaching Hospital, Lagos, Nigeria
| | - Petar Seferovic
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany
| | - Mark R Johnson
- Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, United Kingdom
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Venkatesh KK, Khan SS, Powe CE. Gestational Diabetes and Cardiovascular Health-Reply. JAMA 2024; 331:167-168. [PMID: 38193962 DOI: 10.1001/jama.2023.23254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Kartik K Venkatesh
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Sadiya S Khan
- Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Camille E Powe
- Departments of Medicine and Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts
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24
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Bell KJL, Glasziou PP, Doust JA. Gestational Diabetes and Cardiovascular Health. JAMA 2024; 331:167. [PMID: 38193964 DOI: 10.1001/jama.2023.23251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Katy J L Bell
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Jenny A Doust
- Australian Women and Girls' Health Research (AWaGHR) Centre, School of Public Health, University of Queensland, Herston, Australia
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25
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Ardissino M, Halliday BP, de Marvao A. The global landscape of peripartum cardiomyopathy: Morbidity, mortality, recovery and inequity. Eur J Heart Fail 2024; 26:43-45. [PMID: 38013247 DOI: 10.1002/ejhf.3097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
- Maddalena Ardissino
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, London, UK
- Department of Women and Children's Health, King's College London, London, UK
| | - Brian P Halliday
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton & Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Antonio de Marvao
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, London, UK
- Department of Women and Children's Health, King's College London, London, UK
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
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Jackson AM, Macartney M, Brooksbank K, Brown C, Dawson D, Francis M, Japp A, Lennie V, Leslie SJ, Martin T, Neary P, Venkatasubramanian S, Vickers D, Weir RA, McMurray JJV, Jhund PS, Petrie MC. A 20-year population study of peripartum cardiomyopathy. Eur Heart J 2023; 44:5128-5141. [PMID: 37804234 PMCID: PMC10733720 DOI: 10.1093/eurheartj/ehad626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/23/2023] [Accepted: 09/08/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND AND AIMS The epidemiology of peripartum cardiomyopathy (PPCM) in Europe is poorly understood and data on long-term outcomes are lacking. A retrospective, observational, population-level study of validated cases of PPCM in Scotland from 1998 to 2017 was conducted. METHODS Women hospitalized with presumed de novo left ventricular systolic dysfunction around the time of pregnancy and no clear alternative cause were included. Each case was matched to 10 controls. Incidence and risk factors were identified. Morbidity and mortality were examined in mothers and children. RESULTS The incidence of PPCM was 1 in 4950 deliveries. Among 225 women with PPCM, obesity, gestational hypertensive disorders, and multi-gestation were found to be associated with having the condition. Over a median of 8.3 years (9.7 years for echocardiographic outcomes), 8% of women with PPCM died and 75% were rehospitalized for any cause at least once. Mortality and rehospitalization rates in women with PPCM were ∼12- and ∼3-times that of controls, respectively. The composite of all-cause death, mechanical circulatory support, or cardiac transplantation occurred in 14%. LV recovery occurred in 76% and, of those who recovered, 13% went on to have a decline in LV systolic function despite initial recovery. The mortality rate for children born to women with PPCM was ∼5-times that of children born to controls and they had an ∼3-times greater incidence of cardiovascular disease over a median of 8.8 years. CONCLUSIONS PPCM affected 1 in 4950 women around the time of pregnancy. The condition is associated with considerable morbidity and mortality for the mother and child. There should be a low threshold for investigating at-risk women. Long term follow-up, despite apparent recovery, should be considered.
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Affiliation(s)
- Alice M Jackson
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | | | - Katriona Brooksbank
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | | | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK
| | | | - Alan Japp
- BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | | | | | | | | | | | | | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Mark C Petrie
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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29
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Mattioli AV, Coppi F, Bucciarelli V, Gallina S. Cardiovascular risk stratification in young women: the pivotal role of pregnancy. J Cardiovasc Med (Hagerstown) 2023; 24:793-797. [PMID: 37773880 DOI: 10.2459/jcm.0000000000001557] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Affiliation(s)
- Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena
| | - Francesca Coppi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department-Azienda Ospedaliero-Universitaria delle Marche, Ancona
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
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30
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Pande SN, Yavana Suriya J, Ganapathy S, Pillai AA, Satheesh S, Mondal N, Harichandra Kumar KT, Silversides C, Siu SC, D'Souza R, Keepanasseril A. Validation of Risk Stratification for Cardiac Events in Pregnant Women With Valvular Heart Disease. J Am Coll Cardiol 2023; 82:1395-1406. [PMID: 37758434 DOI: 10.1016/j.jacc.2023.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/13/2023] [Accepted: 07/21/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Most risk stratification tools for pregnant patients with heart disease were developed in high-income countries and in populations with predominantly congenital heart disease, and therefore, may not be generalizable to those with valvular heart disease (VHD). OBJECTIVES The purpose of this study was to validate and establish the clinical utility of 2 risk stratification tools-DEVI (VHD-specific tool) and CARPREG-II-for predicting adverse cardiac events in pregnant patients with VHD. METHODS We conducted a cohort study involving consecutive pregnancies complicated with VHD admitted to a tertiary center in a middle-income setting from January 2019 to April 2022. Individual risk for adverse composite cardiac events was calculated using DEVI and CARPREG-II models. Performance was assessed through discrimination and calibration characteristics. Clinical utility was evaluated with Decision Curve Analysis. RESULTS Of 577 eligible pregnancies, 69 (12.1%) experienced a component of the composite outcome. A majority (94.7%) had rheumatic etiology, with mitral regurgitation as the predominant lesion (48.2%). The area under the receiver-operating characteristic curve was 0.884 (95% CI: 0.844-0.923) for the DEVI and 0.808 (95% CI: 0.753-0.863) for the CARPREG-II models. Calibration plots suggested that DEVI score overestimates risk at higher probabilities, whereas CARPREG-II score overestimates risk at both extremes and underestimates risk at middle probabilities. Decision curve analysis demonstrated that both models were useful across predicted probability thresholds between 10% and 50%. CONCLUSIONS In pregnant patients with VHD, DEVI and CARPREG-II scores showed good discriminative ability and clinical utility across a range of probabilities. The DEVI score showed better agreement between predicted probabilities and observed events.
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Affiliation(s)
- Swaraj Nandini Pande
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - J Yavana Suriya
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sachit Ganapathy
- Department of Biostatistics, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Santhosh Satheesh
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nivedita Mondal
- Department of Neonatology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - K T Harichandra Kumar
- Department of Biostatistics, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Candice Silversides
- Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, University of Toronto, Toronto, Ontario, Canada
| | - Samuel C Siu
- Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, University of Western Ontario, London, Ontario, Canada
| | - Rohan D'Souza
- Department of Obstetrics and Gynaecology and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India.
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31
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Francis AP, Alshowaikh K, Napoleon M, Al-Khan A, Kayaalp E. Venous Thromboembolism Risk Assessment Models in Obstetrics: A Review of Current Practices and Future Directions. Am J Perinatol 2023; 40:1509-1514. [PMID: 35235956 DOI: 10.1055/a-1785-8948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Pregnancy is a major risk factor for venous thromboembolism (VTE) and its associated complications. The hypercoagulable state in both the antenatal and postnatal periods contributes to thromboembolism and continues to be a leading cause of maternal morbidity and mortality worldwide. The non-specific signs and symptoms of VTE in pregnancy and the lack of specific Risk Assessment Models (RAMs) propose a diagnostic challenge in the obstetric population. This review aims to discuss and compare existing RAMs and highlights the important challenges of using established RAMs in obstetric patients. It also emphasizes the importance of enhancing and individualizing RAMs in obstetrics to improve maternal healthcare. KEY POINTS: · VTE is a major complication of pregnancy, associated with increased maternal morbidity and mortality.. · VTE RAMs lack sensitivity and specificity in stratifying VTE risk in pregnancy.. · Validating VTE RAMs in the obstetric population aims to improve maternal outcomes..
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Affiliation(s)
- Antonia P Francis
- Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Khadija Alshowaikh
- Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Melissa Napoleon
- Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Abdulla Al-Khan
- Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Emre Kayaalp
- Department of Obstetrics and Gynecology, Hackensack Meridian Health, Hackensack, New Jersey
- Hackensack Meridian School of Medicine, Nutley, New Jersey
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32
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Ojukwu CP, Nwagha TU, Agbo LC, Ezeigwe AU, Okorie P. Knowledge Levels and Predictors of Venous Thromboembolism among Pregnant Women in Nigeria: A Cross-Sectional Survey for the 'Move for Flow' Programme. West Afr J Med 2023; 40:799-807. [PMID: 37639317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Pregnancy is a significant risk factor for Venous Thromboembolism (VTE) which results in high maternal and perinatal morbidity and mortality rates. Awareness creation is one of the preventable strategies of VTE. To this effect, we designed the 'Move for Flow' program aimed at maternal health education on VTE, its symptoms and preventive strategies. For the best implementation of this program, the current knowledge level of the relevant population is of great interest in guiding the program design and implementation. AIM To assess the knowledge levels of VTE among Nigerian pregnant women. METHODOLOGY In this cross-sectional survey, 1000 pregnant women residing in Enugu, Nigeria, completed a structured questionnaire which assessed their knowledge of VTE, its risk factors and prevention strategies. Quantitatively, their knowledge levels were categorized as no, poor, average and good knowledge. RESULTS The majority of the respondents did not know about pregnancy-related deep vein thrombosis (DVT) (80.8%) and pulmonary embolism (PE) (88.9). Predictors of DVT knowledge levels include husbands' level of education (at most secondary education) (AOR = 4.2; 95%CI = 2.554-6.816; p = <0.001) and maternal age (AOR = 0.9; 95% CI = 0.930-0.999; p = 0.044) while predictors of PE knowledge level include husbands' level of education (at most secondary education) (AOR = 2.1; 95%CI = 1.005-4.436; p = 0.048) and maternal occupation (professionals) (AOR = 0.4; 95% CI = 0.219- 0.794; p = 0.008). CONCLUSION Pregnant women are unaware of pregnancy-related VTE in Enugu, Nigeria. Immediate designing and implementation of the 'Move for Flow' program are recommended to improve maternal knowledge levels of VTE.
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Affiliation(s)
- C P Ojukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria, Enugu State, Nigeria
| | - T U Nwagha
- Coagulation Unit, Department of Haematology and Immunology, College of Medicine, The University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria
| | - L C Agbo
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, University of Nigeria, Enugu State, Nigeria
| | - A U Ezeigwe
- Department of Physiotherapy, Enugu State University Teaching Hospital Parklane, Enugu State, Nigeria
| | - P Okorie
- Coagulation Unit, Department of Haematology and Immunology, College of Medicine, The University of Nigeria Teaching Hospital, Ituku Ozalla, Nigeria
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33
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Abdelnabi M, Almaghraby A, Abdelgawad H, Saleh Y. Socioeconomic disparities in peripartum cardiomyopathy. Eur Heart J 2023; 44:2795-2796. [PMID: 37313596 DOI: 10.1093/eurheartj/ehad385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/12/2023] [Accepted: 05/26/2023] [Indexed: 06/15/2023] Open
Affiliation(s)
- Mahmoud Abdelnabi
- Internal Medicine Department, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Abdallah Almaghraby
- Cardiology Department, Ibrahim Bin Hamad Hospital, Al Nakheel, Ras Al Khaimah, 10190, UAE
| | - Hoda Abdelgawad
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Cardiology Department, King's college hospital NHS Trust, London, UK
| | - Yehia Saleh
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Cardiology Department, Houston Methodist DeBakey Cardiology Associates, Houston, TX, USA
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34
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Monda E, Limongelli G. Thromboembolic events in peripartum cardiomyopathy: Current dilemmas and future perspectives. Eur J Heart Fail 2023; 25:1467-1469. [PMID: 37323088 DOI: 10.1002/ejhf.2937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Naples, Italy
- University College London, Institute of Cardiovascular Science, London, UK
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, Naples, Italy
- University College London, Institute of Cardiovascular Science, London, UK
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35
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Yaniv-Salem S, Dym L, Nesher L, Zahger D, Shalev A, Shmueli H. Post-COVID-19 Peripartum Cardiomyopathy: Experience from a Large Tertiary Referral Center. Isr Med Assoc J 2023; 25:533-537. [PMID: 37574890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a rare but potentially devastating complication of pregnancy. Although the pathophysiology of PPCM is not fully understood, there are known risk factors for developing PPCM, which are maternal and gestation related. In the first wave of the coronavirus disease 2019 (COVID-19) pandemic, we witnessed an elevated incidence of PPCM among COVID-19 survivors. OBJECTIVES To present a single-center case series of three patients diagnosed with peripartum cardiomyopathy after recovered from COVID-19 during the index pregnancy. METHODS In this single center case study, all patients diagnosed with PPCM at our institute during the examined time frame were included. Electronic medical records were studied. RESULTS Three patients previously diagnosed with asymptomatic or mildly symptomatic COVID-19 disease during pregnancy presented with PPCM before or shortly after delivery. Patients underwent testing to rule out residual COVID-19 myocarditis, were treated pharmacologically and with wearable defibrillators as needed, and were examined in follow-up 1-9 months after delivery. CONCLUSIONS Residual endothelial damage due to COVID-19 disease, even if originally mild in presentation, could predispose pregnant patients to PPCM and should be considered as a risk factor when assessing patients with new onset symptoms of heart failure. Further research is needed to confirm this hypothesis and fully determine the underlying pathophysiology. These preliminary findings warrant a high index of suspicion for PPCM in COVID-19 recoverers.
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Affiliation(s)
- Shimrit Yaniv-Salem
- Department of Gynecology and Obstetrics, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Lianne Dym
- Department of Gynecology and Obstetrics, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Nesher
- Department of Infectious Diseases, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Zahger
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Aryeh Shalev
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Hezzy Shmueli
- Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Tromp J, Jackson AM, Abdelhamid M, Fouad D, Youssef G, Petrie MC, Bauersachs J, Sliwa K, van der Meer P. Thromboembolic events in peripartum cardiomyopathy: Results from the ESC EORP PPCM registry. Eur J Heart Fail 2023; 25:1464-1466. [PMID: 37092321 DOI: 10.1002/ejhf.2871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/18/2023] [Accepted: 04/15/2023] [Indexed: 04/25/2023] Open
Affiliation(s)
- Jasper Tromp
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Alice M Jackson
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | - Doaa Fouad
- Assiut University Heart Hospital, Assiut, Egypt
| | - Ghada Youssef
- Cardiology Department, Kasr Al Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mark C Petrie
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Department of Medicine and Cardiology, University of Cape Town, Cape Town, South Africa
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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37
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Ávila MIL, Marques MG, da Rocha MEAM, Dos Santos FC, Ochtrop MLG, de Jesús NR, de Jesús GRR, Elias CSO. Evaluation of obstetric outcomes in Brazilian pregnant women with Takayasu arteritis. Adv Rheumatol 2023; 63:35. [PMID: 37496093 DOI: 10.1186/s42358-023-00314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Takayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA. METHODS This is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021. RESULTS In twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful. CONCLUSION Although there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients.
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Affiliation(s)
- Marcela Ignacchiti Lacerda Ávila
- Deparment of Obstetrics, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Marcela Gaiotti Marques
- Deparment of Obstetrics, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Flávia Cunha Dos Santos
- Deparment of Obstetrics, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Manuella Lima Gomes Ochtrop
- Deparment of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nilson Ramires de Jesús
- Deparment of Obstetrics, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Camila Souto Oliveira Elias
- Deparment of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Cameron NA, Yee LM, Dolan BM, O'Brien MJ, Greenland P, Khan SS. Trends in Cardiovascular Health Counseling Among Postpartum Individuals. JAMA 2023; 330:359-367. [PMID: 37490084 PMCID: PMC10369213 DOI: 10.1001/jama.2023.11210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
Importance Poor prepregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are key risk factors for subsequent cardiovascular disease (CVD) in birthing adults. The postpartum visit offers an opportunity to promote CVH among at-risk individuals. Objective To determine prevalence, predictors, and trends in self-reported CVH counseling during the postpartum visit. Design, Setting, and Participants Serial, cross-sectional analysis of data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a nationally representative, population-based survey. The primary analysis included individuals who attended a postpartum visit 4 to 6 weeks after delivery with available data on receipt of CVH counseling, self-reported prepregnancy CVD risk factors (obesity, diabetes, and hypertension), and APOs (gestational diabetes, hypertensive disorders of pregnancy, and preterm birth) (N = 167 705 [weighted N = 8 714 459]). Exposures Total number of CVD risk factors (0, 1, or ≥2 prepregnancy risk factors or APOs). Main Outcomes and Measures Annual, age-adjusted prevalence of self-reported postpartum CVH counseling per 100 individuals, defined as receipt of counseling for healthy eating, exercise, and losing weight gained during pregnancy, was calculated overall and by number of CVD risk factors. Average annual percent change (APC) assessed trends in CVH counseling from 2016 through 2020. Data were pooled to calculate rate ratios (RRs) for counseling that compared individuals with and without CVD risk factors after adjustment for age, education, postpartum insurance, and delivery year. Results From 2016 through 2020, prevalence of self-reported postpartum CVH counseling declined from 56.2 to 52.8 per 100 individuals among those with no CVD risk factors (APC, -1.4% [95% CI, -1.8% to -1.0%/y]), from 58.5 to 57.3 per 100 individuals among those with 1 risk factor (APC, -0.7% [95% CI, -1.3% to -0.1%/y]), and from 61.9 to 59.8 per 100 individuals among those with 2 or more risk factors (APC, -0.8% [95% CI, -1.3% to -0.3%/y]). Reporting receipt of counseling was modestly higher among individuals with 1 risk factor (RR, 1.05 [95% CI, 1.04 to 1.07]) and with 2 or more risk factors (RR, 1.11 [95% CI, 1.09 to 1.13]) compared with those who had no risk factors. Conclusions and Relevance Approximately 60% of individuals with CVD risk factors or APOs reported receiving CVH counseling at their postpartum visit. Prevalence of reporting CVH counseling decreased modestly over 5 years.
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Affiliation(s)
- Natalie A Cameron
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Lynn M Yee
- Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Northwestern University, Chicago, Illinois
| | - Brigid M Dolan
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Matthew J O'Brien
- Feinberg School of Medicine, Department of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, Illinois
| | - Philip Greenland
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Sadiya S Khan
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
- Feinberg School of Medicine, Department of Medicine, Division of Cardiology, Northwestern University, Chicago, Illinois
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Harris E. Cardiac Arrest Rates in Pregnancy Might Be Higher Than Expected. JAMA 2023; 329:1143. [PMID: 36947077 DOI: 10.1001/jama.2023.4007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
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Parrini I, Lucà F, Favilli S, Domenicucci S, Russo MG, Sarubbi B, Gelsomino S, Colivicchi F, Gulizia MM. [Pregnancy and heart disease: the role of the Pregnancy Heart Team]. G Ital Cardiol (Rome) 2022; 23:631-644. [PMID: 36169143 DOI: 10.1714/3856.38394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A significant risk of maternal and fetal morbidity and mortality has been shown to be associated with congenital heart disease or heart disease occurring during pregnancy. Given the increasing number of patients with corrected congenital heart disease who reach fertile age and the more and more common advanced maternal age associated with preexisting or intercurrent comorbidities, a higher incidence of cardiac complications in pregnancy has been reported in the last decades. Improvement in maternal and neonatal outcomes is influenced by a multidisciplinary strategy. The purpose of this review is to assess the role of the Pregnancy Heart Team which should ensure careful pre-pregnancy counseling, pregnancy monitoring, and delivery planning for both congenital heart disease and other cardiac or metabolic disorders.
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Affiliation(s)
- Iris Parrini
- Divisione di Cardiologia, Ospedale Mauriziano, Torino
| | - Fabiana Lucà
- U.O. Cardiologia, UTIC, Grande Ospedale Metropolitano, Azienda Ospedaliera Bianchi Melacrino Morelli, Reggio Calabria
| | - Silvia Favilli
- S.O.C. Cardiologia Pediatrica e della Transizione, AOU Meyer, Firenze
| | | | - Maria Giovanna Russo
- U.O.C. Cardiologia Pediatrica e U.O.S.D. Cardiopatie Congenite dell'Adulto, Università della Campania "L. Vanvitelli", Ospedale Monaldi, Napoli
| | - Berardo Sarubbi
- U.O.C. Cardiologia Pediatrica e U.O.S.D. Cardiopatie Congenite dell'Adulto, Università della Campania "L. Vanvitelli", Ospedale Monaldi, Napoli
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht - CARIM, University of Maastricht, Maastricht, Olanda
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, Dipartimento di Emergenza e Accettazione, Presidio Ospedaliero San Filippo Neri, ASL Roma 1, Roma
| | - Michele Massimo Gulizia
- Divisione di Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania - Fondazione per il Tuo cuore - Heart Care Foundation, Firenze
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Fernandez Campos BA, Silversides CK. Marfan syndrome and pregnancy-related aortic complications: contemporary outcomes from two Spanish Marfan units. Rev Esp Cardiol (Engl Ed) 2022; 75:542-544. [PMID: 35339410 DOI: 10.1016/j.rec.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Beatriz Aldara Fernandez Campos
- University of Toronto, Division of Cardiology, Toronto Congenital Cardiac Centre for Adults, University Health Network and Mount Sinai Hospital, Toronto, Canada
| | - Candice K Silversides
- University of Toronto, Division of Cardiology, Toronto Congenital Cardiac Centre for Adults, University Health Network and Mount Sinai Hospital, Toronto, Canada.
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Ye W, Thangavel G, Pillarisetti A, Steenland K, Peel JL, Balakrishnan K, Jabbarzadeh S, Checkley W, Clasen T. Association between personal exposure to household air pollution and gestational blood pressure among women using solid cooking fuels in rural Tamil Nadu, India. Environ Res 2022; 208:112756. [PMID: 35065931 PMCID: PMC8935388 DOI: 10.1016/j.envres.2022.112756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/06/2022] [Accepted: 01/15/2022] [Indexed: 05/22/2023]
Abstract
BACKGROUND The Household Air Pollution Intervention Network (HAPIN) trial is an ongoing multi-center randomized controlled trial assessing the impact of a liquified petroleum gas (LPG) cookstove and fuel intervention on health. Given the potential impacts of household air pollution (HAP) exposure from burning solid fuels on cardiovascular health during pregnancy, we sought to determine whether baseline exposures to particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5), black carbon (BC) and carbon monoxide (CO) were associated with blood pressure among 799 pregnant women in Tamil Nadu, India, one of the HAPIN trial centers. METHODS Multivariable linear regression models were used to examine the association between 24-h personal exposure to PM2.5/BC/CO and systolic and diastolic blood pressure, controlling for maternal age, body mass index (BMI), mother's education, household wealth, gestational age, and season. At the time of measurement, women were between 9- and 20-weeks of gestation. RESULTS We found that systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in pregnant women exposed to higher levels of HAP, though only the result for CO and DBP reached conventional statistical significance (p < 0.05). We observed a positive association between CO and DBP among the entire study cohort: a 1-log μg/m3 increase in CO exposure was associated with 0.36 mmHg higher DBP (95% confidence interval [CI]: 0.02 to 0.70). The effect was stronger in pregnant women with higher CO exposures (in the 3rd [≥ 0.9 and < 2.1 ppm] and 4th quartiles [≥ 2.1 and ≤ 46.9 ppm]). We also found that pregnant women with PM2.5 exposures in the highest quartile (≥ 129.9 and ≤ 2100 μg/m3) had a borderline significant association (p = 0.054) with DBP compared to those who had PM2.5 exposures in the lowest quartile (≥ 9.4 and < 47.7 μg/m3). No evidence of association was observed for BC exposure and blood pressure. CONCLUSION This study contributes to limited evidence regarding the relationship between HAP exposure and blood pressure among women during pregnancy, a critical window for both mother and child's life-course health. Results from this cross-sectional study suggest that exposures to PM2.5 and CO from solid fuel use are associated with higher blood pressure in pregnant women during their first or second trimester.
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Affiliation(s)
- Wenlu Ye
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| | - Kyle Steenland
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer L Peel
- Dept of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas Clasen
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Riise HKR, Igland J, Sulo G, Iversen MM, Graue M, Eskild A, Tell GS, Daltveit AK. Is the risk of cardiovascular disease in women with pre-eclampsia modified by very low or very high offspring birth weight? A nationwide cohort study in Norway. BMJ Open 2022; 12:e055467. [PMID: 35473727 PMCID: PMC9045054 DOI: 10.1136/bmjopen-2021-055467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine whether the risk of cardiovascular disease (CVD) in women with pre-eclampsia is modified by very low or very high offspring birth weight. Further, we studied whether diabetes in pregnancy modified this risk. DESIGN Nationwide cohort study. SETTING Norwegian population registries. PARTICIPANTS 618 644 women who gave birth to their first child during 1980-2009. METHODS The women were followed from delivery until the development of CVD or censoring, by linkage of the Medical Birth Registry of Norway to the Cardiovascular Disease in Norway project, and the Norwegian Cause of Death Registry. PRIMARY OUTCOME MEASURE CVD. RESULTS Compared with normotensive women with normal offspring birth weight, women with pre-eclampsia had increased risk of CVD (HR 2.16; 95% CI 2.05 to 2.26). The CVD risk was even higher when pre-eclampsia was accompanied with a large for gestational age offspring (LGA, z-score >2.0) (HR 2.57; 95% CI 2.08 to 3.18). Women with pre-eclampsia and a small for gestational age offspring (SGA, z-score <-2.0) had an HR of 1.54 (95% CI 1.23 to 1.93) compared with normotensive women with normal offspring birth weight.Also, women with diabetes had increased CVD risk, but no additional risk associated with an LGA or SGA offspring. CONCLUSIONS Women with pre-eclampsia and an LGA offspring had higher risk of CVD than pre-eclamptic women with a normal weight (z-score -2.0 to 2.0) or SGA offspring. These findings suggest that factors causing pre-eclampsia and an LGA offspring are also linked to development of CVD.
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Affiliation(s)
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Vestlandet, Norway
| | - Gerhard Sulo
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne Eskild
- Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Grethe Seppola Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Vestlandet, Norway
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Vestlandet, Norway
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Oslo, Norway
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Putra ICS, Irianto CB, Raffaello WM, Suciadi LP, Prameswari HS. Pre-pregnancy Obesity and the Risk of Peripartum Cardiomyopathy: A Systematic Review and Meta-Analysis. Indian Heart J 2022; 74:235-238. [PMID: 35490847 PMCID: PMC9243620 DOI: 10.1016/j.ihj.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/24/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
The outcome of this review is to assess the association between pre-pregnancy obesity and PPCM incidence. There were a total of 5.373.581 participants were included in this study. Pre-pregnancy obesity was significantly associated with PPCM incidence compared to normal-weight subjects (OR = 1.79 (1.16,2.76); p = 0.008; I2 = 59%, Pheterogeneity = 0.04). The sub-group analysis showed that pre-pregnancy women with obesity class I (OR = 1.58 (1.20,2.07); p = 0.001; I2 = 0%, Pheterogeneity = 0.64) and class II and III (OR = 2.65 (2.04,3.45); p < 0.001; I2 = 6%, Pheterogeneity = 0.36) was significantly associated with PPCM incidence compared to normal-weight subjects.
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Affiliation(s)
- Iwan Cahyo Santosa Putra
- School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
| | - Christian Bobby Irianto
- School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
| | | | | | - Hawani Sasmaya Prameswari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.
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Bukhari S, Fatima S, Barakat AF, Fogerty AE, Weinberg I, Elgendy IY. Venous thromboembolism during pregnancy and postpartum period. Eur J Intern Med 2022; 97:8-17. [PMID: 34949492 DOI: 10.1016/j.ejim.2021.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022]
Abstract
Venous thromboembolism (VTE) is one of the leading causes of maternal mortality. Rates of VTE during pregnancy and the postpartum period have not decreased over the past two decades and pregnancyassociated VTE continues to pose a significant health challenge. Pregnant and postpartum women are at a higher risk for VTE owing to many factors. There are hormonally mediated and pregnancy-specific alterations of coagulation that favor thrombosis, including increased production of clotting factors. There are physiologic and anatomic mechanisms that also contribute, including a decreased rate of venous blood flow from the lower extemities as pregnancy progresses. Cesarean delivery also introduces VTE risk. In addition, studies have demonstrated that pregnancy-associated complications such as pre-eclampsia or peri-partum infections are associated with increased VTE rates. In this review, we discuss the recent epidemiological studies, pathogenesis, risk factors and clinical presentation as well as therapeutic options for VTE during pregnancy and the postpartum period. We also provide proposed diagnostic algorithms for diagnosis and management of VTE during pregnancy and the postpartum period based on updated evidence. Finally, we highlight knowledge gaps to guide future research.
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Affiliation(s)
- Syed Bukhari
- Department of Medicine, Temple University, Philadelphia, PA
| | - Shumail Fatima
- Department of Medicine, University of Pittsburgh Medical Center McKeesport Hospital, McKeesport, PA
| | - Amr F Barakat
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Annemarie E Fogerty
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ido Weinberg
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
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Affiliation(s)
- Michael C. Honigberg
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA
| | - Seyedeh M. Zekavat
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA
- Computational Biology and Bioinformatics Program, Yale University, New Haven, CT
| | - Vineet K. Raghu
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Pradeep Natarajan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA
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Okoth K, Subramanian A, Chandan JS, Adderley NJ, Thomas GN, Nirantharakumar K, Antza C. Long term miscarriage-related hypertension and diabetes mellitus. Evidence from a United Kingdom population-based cohort study. PLoS One 2022; 17:e0261769. [PMID: 35061706 PMCID: PMC8782476 DOI: 10.1371/journal.pone.0261769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Miscarriages affect up to a fifth of all pregnancies and are associated with substantial psychological morbidity. However, their relationship with cardiometabolic risk factors is not well known. Therefore, in this study we aimed to estimate the burden of cardiovascular risk factors including diabetes mellitus (type 1 or 2) and hypertension in women with miscarriage compared to women without a record of miscarriage. METHODS A population-based retrospective cohort study was conducted using IVQIA Medical Research Data UK (IMRD-UK) between January 1995 and May 2016, an anonymised electronic health records database that is representative of the UK population. A total of 86,509, 16-50-year-old women with a record of miscarriage (exposed group) were matched by age, smoking status, and body mass index to 329,865 women without a record of miscarriage (unexposed group). Patients with pre-existing hypertension and diabetes were excluded. Adjusted incidence rate ratios (aIRR) and 95% confidence intervals (95% CI) for diabetes and hypertension were estimated using multivariable Poisson regression models offsetting for person-years follow-up. RESULTS The mean age at cohort entry was 31 years and median follow up was 4.6 (IQR 1.7-9.4) years. During the study period, a total of 792 (IR 1.44 per 1000 years) and 2525 (IR 1.26 per 1000 years) patients developed diabetes in the exposed and unexposed groups, respectively. For hypertension, 1995 (IR 3.73 per 1000 years) and 1605 (IR 3.39 per 1000 years) new diagnoses were recorded in the exposed and unexposed groups, respectively. Compared to unexposed individuals, women with a record miscarriage were more likely to develop diabetes (aIRR = 1.25, 95% CI: 1.15-1.36; p<0.001) and hypertension (aIRR = 1.07, 95% CI: 1.02-1.12; p = 0.005). CONCLUSIONS Women diagnosed with miscarriage were at increased risk of developing diabetes mellitus and hypertension. Women with history of miscarriage may benefit from periodic monitoring of their cardiometabolic health.
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Affiliation(s)
- Kelvin Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Nicola J. Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - G. Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Christina Antza
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
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Wilkie GL, Qureshi WT, O'Day KW, Aurigemma GP, Goldberg RJ, Amjad W, Alqalyoobi S, Kakouros N, Lauring JR, Leftwich HK, Harrington CM. Cardiac and Obstetric Outcomes Associated With Mitral Valve Prolapse. Am J Cardiol 2022; 162:150-155. [PMID: 34689956 DOI: 10.1016/j.amjcard.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
Abstract
Mitral valve prolapse (MVP) is the most common valvular heart disease in women of reproductive age. Whether MVP increases the likelihood of adverse outcomes in pregnancy is unknown. The study objective was to examine the cardiac and obstetric outcomes associated with MVP in pregnant women. This retrospective cohort study, using the Healthcare Cost and Utilization Project National Readmission Sample database between 2010 and 2017, identified all pregnant women with MVP using the International Classification of Disease, Ninth and Tenth Revisions codes. The maternal cardiac and obstetric outcomes in pregnant women diagnosed with MVP were compared with women without MVP using multivariable logistic and Cox proportional hazard regression models adjusted for baseline demographic characteristics. There were 23,000 pregnancy admissions with MVP with an overall incidence of 16.9 cases per 10,000 pregnancy admissions. Pregnant women with MVP were more likely to die during pregnancy (adjusted hazard ratio 5.13, 95% confidence interval [CI] 1.09 to 24.16), develop cardiac arrest (adjusted odds ratio [aOR] 4.44, 95% CI 1.04 to 18.89), arrhythmia (aOR 10.96, 95% CI 9.17 to 13.12), stroke (aOR 6.90, 95% CI 1.26 to 37.58), heart failure (aOR 5.81, 95% CI 3.84 to 8.79), or suffer a coronary artery dissection (aOR 25.22, 95% CI 3.42 to 186.07) compared with women without MVP. Pregnancies with MVP were also associated with increased risks of preterm delivery (aOR 1.21, 95% CI 1.02 to 1.44) and preeclampsia/hemolysis, elevated liver enzymes, and low platelets syndrome (aOR 1.22, 95% CI 1.05 to 1.41). In conclusion, MVP in pregnancy is associated with adverse maternal cardiac outcomes and higher obstetric risks.
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Affiliation(s)
- Gianna L Wilkie
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Memorial Healthcare
| | - Waqas T Qureshi
- Division of Cardiovascular Medicine, University of Massachusetts Memorial Healthcare
| | - Kevin W O'Day
- Division of Cardiovascular Medicine, University of Massachusetts Memorial Healthcare
| | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, University of Massachusetts Memorial Healthcare
| | - Robert J Goldberg
- Division of Cardiovascular Medicine, University of Massachusetts Memorial Healthcare; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Waseem Amjad
- Department of Internal Medicine, Albany Medical College, Albany, New York
| | - Shehabaldin Alqalyoobi
- Department of Pulmonary and Critical Care Medicine, East Carolina University, Greenville, North Carolina; Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky
| | - Nikolaos Kakouros
- Division of Cardiovascular Medicine, University of Massachusetts Memorial Healthcare
| | - Julianne R Lauring
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Memorial Healthcare
| | - Heidi K Leftwich
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Memorial Healthcare
| | - Colleen M Harrington
- Division of Cardiovascular Medicine, University of Massachusetts Memorial Healthcare.
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Son SL, Hosek LL, Stein MC, Allshouse AA, Catino AB, Hoskoppal AK, Cox DA, Whitehead KJ, Lindsay IM, Esplin S, Metz TD. Association between pregnancy and long-term cardiac outcomes in individuals with congenital heart disease. Am J Obstet Gynecol 2022; 226:124.e1-124.e8. [PMID: 34331895 PMCID: PMC8748281 DOI: 10.1016/j.ajog.2021.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND As early life interventions for congenital heart disease improve, more patients are living to adulthood and are considering pregnancy. Scoring and classification systems predict the maternal cardiovascular risk of pregnancy in the context of congenital heart disease, but these scoring systems do not assess the potential subsequent risks following pregnancy. Data on the long-term cardiac outcomes after pregnancy are unknown for most lesion types. This limits the ability of healthcare practitioners to thoroughly counsel patients who are considering pregnancy in the setting of congenital heart disease. OBJECTIVE We aimed to evaluate the association between pregnancy and the subsequent long-term cardiovascular health of individuals with congenital heart disease. STUDY DESIGN This was a retrospective longitudinal cohort study of individuals identifying as female who were receiving care in two adult congenital heart disease centers from 2014 to 2019. Patient data were abstracted longitudinally from a patient age of 15 years (or from the time of entry into the healthcare system) to the conclusion of the study, death, or exit from the healthcare system. The primary endpoint, a composite adverse cardiac outcome (death, stroke, heart failure, unanticipated cardiac surgery, or a requirement for a catheterized procedure), was compared between parous (at least one pregnancy >20 weeks' gestation) and nulliparous individuals. By accounting for differences in the follow-up, the effect of pregnancy was estimated based on the time to the composite adverse outcome in a proportional hazards regression model adjusted for the World Health Organization class, baseline cardiac medications, and number of previous sternotomies. Participants were also categorized according to their lesion type, including septal defects (ventricular septal defects, atrial septal defects, atrioventricular septal defects, or atrioventricular canal defects), right-sided valvular lesions, left-sided valvular lesions, complex cardiac anomalies, and aortopathies, to evaluate if there is a differential effect of pregnancy on the primary outcome when adjusting for lesion type in a sensitivity analysis. RESULTS Overall, 711 individuals were eligible for inclusion; 209 were parous and 502 nulliparous. People were classified according to the World Health Organization classification system with 86 (12.3%) being classified as class I, 76 (10.9%) being classified as class II, 272 (38.9%) being classified as class II to III, 155 (22.1%) being classified as class III, and 26 (3.7%) being classified as class IV. Aortic stenosis, bicuspid aortic valve, dilated ascending aorta or aortic root, aortic regurgitation, and pulmonary insufficiency were more common in parous individuals, whereas dextro-transposition of the great arteries, Turner syndrome, hypoplastic right heart, left superior vena cava, and other cardiac diagnoses were more common in nulliparous individuals. In multivariable modeling, pregnancy was associated with the composite adverse cardiac outcome (36.4%% vs 26.1%%; hazard ratio, 1.83; 95% confidence interval, 1.25-2.66). Parous individuals were more likely to have unanticipated cardiac surgery (28.2% vs 18.1%; P=.003). No other individual components of the primary outcome were statistically different between parous and nulliparous individuals in cross-sectional comparisons. The association between pregnancy and the primary outcome was similar in a sensitivity analysis that adjusted for cardiac lesion type (hazard ratio, 1.61; 95% confidence interval, 1.10-2.36). CONCLUSION Among individuals with congenital heart disease, pregnancy was associated with an increase in subsequent long-term adverse cardiac outcomes. These data may inform counseling of individuals with congenital heart disease who are considering pregnancy.
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Affiliation(s)
- Shannon L Son
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, UT.
| | - Lauren L Hosek
- University of Utah School of Medicine, Salt Lake City, UT
| | | | - Amanda A Allshouse
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT
| | - Anna B Catino
- Division of Cardiology, University of Utah Health, Salt Lake City, UT
| | - Arvind K Hoskoppal
- Division of Cardiology, University of Utah Health, Salt Lake City, UT; Division of Cardiology, Intermountain Healthcare, Salt Lake City, UT
| | - Daniel A Cox
- Division of Cardiology, University of Utah Health, Salt Lake City, UT; Division of Cardiology, Intermountain Healthcare, Salt Lake City, UT
| | - Kevin J Whitehead
- Division of Cardiology, University of Utah Health, Salt Lake City, UT; Division of Cardiology, Intermountain Healthcare, Salt Lake City, UT
| | - Ian M Lindsay
- Division of Cardiology, University of Utah Health, Salt Lake City, UT; Division of Cardiology, Intermountain Healthcare, Salt Lake City, UT
| | - Sean Esplin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, UT
| | - Torri D Metz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, UT
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Steiner JM, Lokken E, Bayley E, Pechan J, Curtin A, Buber J, Albright C. Cardiac and Pregnancy Outcomes of Pregnant Patients With Congenital Heart Disease According to Risk Classification System. Am J Cardiol 2021; 161:95-101. [PMID: 34635313 PMCID: PMC10686784 DOI: 10.1016/j.amjcard.2021.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
Pregnancy risk assessment for patients with adult congenital heart disease (ACHD) must include physiologic and anatomic impacts. We aimed to determine whether maternal cardiac and pregnancy outcomes vary by disease severity defined according to the following 3 different classifications: ACHD anatomic severity, ACHD physiologic class, and modified World Health Organization (mWHO) class. Cardiac outcomes included a composite of arrhythmia, heart failure, stroke, and thromboembolism. Pregnancy outcomes included a composite of intrauterine growth restriction, preterm birth, preeclampsia, or postpartum hemorrhage. We employed generalized estimating equations to account for multiple pregnancies. Of the 245 pregnancies, 17.1% were preterm and 45.7% were cesarean deliveries. Cardiac hospitalizations occurred in 22.0% and arrhythmias in 12.7%. Cardiac outcomes tended to be more prevalent in people with more severe heart disease. Pregnancy outcomes were U-shaped or less prevalent in people with more severe disease. There was a 2.9-fold increased risk for the composite cardiac outcome for complex anatomy (adjusted incidence rate ratio 2.90, 95% confidence interval 1.08 to 7.81, p = 0.04), a 9.4-fold increased risk for physiologic class C or D (9.37, 1.28 to 68.79, p = 0.03), and a fourfold increased risk for mWHO class III or IV (3.99, 1.53 to 10.40, p = 0.005). There was a lower risk for the composite pregnancy outcome for mWHO class II or II to III (0.54, 0.36 to 0.79, p = 0.002) but no association with anatomy or physiology. In conclusion, physiologic class may be most accurately associated with adverse outcomes and therefore efforts to optimize hemodynamics before pregnancy may help to mitigate the risk.
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Affiliation(s)
| | - Erica Lokken
- Department of Obstetrics and Gynecology; Department of Global Health, University of Washington, Seattle, Washington
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