Perinatal Outcome in Pregnant Women with Heart Disease

Noopur   R.   Kedia; Mohit      Kejariwal; Malay      Jhancy

Abstract

With improved technology and better access to health care, the number of pregnant women with heart diseases is increasing. Due to various physiological changes in pregnancy, women with heart diseases are at increased risk of both maternal and fetal complications. Thus, pregnancy with heart disease is considered a high-risk pregnancy. In the near future, the burden on the healthcare system will increase and we will be required to answer various questions about the different outcomes possible and their management. If women are made aware of the various risks associated with their pregnancies, they can make informed life choices. This can only be achieved if more objective data is offered to her [1]. In this article, we review the available data on the observed perinatal outcomes in mothers with heart disease, their management, and what lacunas need to be filled, so as to be able to provide better care. Relevant articles were referred and data was summed. We concluded that in the majority of studies, the odds for adverse neonatal outcomes like preterm birth, low birth weight, stillbirth, low Apgar score and admissions to neonatal intensive care unit were higher among pregnant women with heart disease as compared to women with no heart disease.

Keywords: Pregnancy, Heart disease, Perinatal outcome, Fetal complications, Preterm birth, Congenital heart disease.

[1]
Koutrolou-Sotiropoulou P, Parikh PB, Miller C, Lima FV, Butler J, Stergiopoulos K. Impact of heart disease on maternal and fetal outcomes in pregnant women. Am J Cardiol  2015; 116(3): 474-80.
 [http://dx.doi.org/10.1016/j.amjcard.2015.04.063]

[2]
Regitz-zagrosek V, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Kardiol Pol  2019; 77: 245-326.

[3]
Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol  2009; 33(3): 130-7.
 [http://dx.doi.org/10.1053/j.semperi.2009.02.010] [PMID: 19464502]

[4]
Owens A, Yang J, Nie L, Lima F, Avila C, Stergiopoulos K. Neonatal and maternal outcomes in pregnant women with cardiac disease. J Am Heart Assoc  2018; 7: e009395.
 [http://dx.doi.org/10.1161/JAHA.118.009395]

[5]
Opotowsky AR, Siddiqi OK, webb GD. Trends in hospitalizations for adults with congenital heart disease in the U.S. J Am Coll Cardiol  2009; 54: 460-7.

[6]
Zeitlin J, Mohangoo AD, Delnord M, Cuttini M. The second European Perinatal Health Report: documenting changes over 6 years in the health of mothers and babies in Europe. J Epidemiol Community Health  2013; 67(12): 983-5.
 [http://dx.doi.org/10.1136/jech-2013-203291] [PMID: 24052513]

[7]
Lima FV, Yang J, Xu J, Stergiopoulos K. National trends and in-hospital outcomes in pregnant women with heart disease in the united states. Am J Cardiol  2017; 119(10): 1694-700.
 [http://dx.doi.org/10.1016/j.amjcard.2017.02.003] [PMID: 28343597]

[8]
Sliwa K, Böhm M. Incidence and prevalence of pregnancy-related heart disease. Cardiovasc Res  2014; 101(4): 554-60.
 [http://dx.doi.org/10.1093/cvr/cvu012] [PMID: 24459193]

[9]
Lima FV, Parikh PB, Zhu J, Yang J, Stergiopoulos K. Association of cardiomyopathy with adverse cardiac events in pregnant women at the time of delivery. JACC Heart Fail  2015; 3(3): 257-66.
 [http://dx.doi.org/10.1016/j.jchf.2014.10.008] [PMID: 25742764]

[10]
Lima FV, Koutrolou-Sotiropoulou P, Yen TYM, Stergiopoulos K. Clinical characteristics and outcomes in pregnant women with Ebstein anomaly at the time of delivery in the USA: 2003–2012. Arch Cardiovasc Dis  2016; 109(6-7): 390-8.
 [http://dx.doi.org/10.1016/j.acvd.2016.01.010] [PMID: 27079467]

[11]
Wolfe DS, Hameed AB, Taub CC, Zaidi AN, Bortnick AE. Addressing maternal mortality: the pregnant cardiac patient. Am J Obstetrics Gynecol  2019; 220(2): 167e1-8.

[12]
Maganti K, Rigolin VH, Sarano ME, Bonow RO. Valvular heart disease: diagnosis and management. Mayo Clin Proc  2010; 85(5): 483-500.
 [http://dx.doi.org/10.4065/mcp.2009.0706] [PMID: 20435842]

[13]
Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol  2011; 8(3): 162-72.
 [http://dx.doi.org/10.1038/nrcardio.2010.202] [PMID: 21263455]

[14]
LaHaye S, Lincoln J, Garg V. Genetics of valvular heart disease. Curr Cardiol Rep  2014; 16(6): 487.
 [http://dx.doi.org/10.1007/s11886-014-0487-2] [PMID: 24743897]

[15]
Rose AG. Etiology of valvular heart disease. Curr Opin Cardiol  1996; 11(2): 98-113.
 [http://dx.doi.org/10.1097/00001573-199603000-00002] [PMID: 8736680]

[16]
Iftikhar SF, Biswas M. Cardiac disease in pregnancy. In: StatPearls. Treasure Island (FL): StatPearls Publishing 2022.

[17]
Salam S. Maternal and fetal outcome in pregnancy with heart disease in tertiary care hospital in india. Int J Reprod Contracept Obstetr Gynecol  2017; 6(9): 3947-51.
 [http://dx.doi.org/10.18203/2320-1770.ijrcog20174041]

[18]
Bhatla N, Lal S, Behera G, et al. Cardiac disease in pregnancy. Int J Gynaecol Obstet  2003; 82(2): 153-9.
 [http://dx.doi.org/10.1016/S0020-7292(03)00159-0] [PMID: 12873775]

[19]
Chumpathong S, Sirithaweesit C, Pechpaisit N, et al. Predictors for complications in pregnant women with heart disease, a retrospective study. J Med Assoc Thai  2014; 97(7): 730-5.
 [PMID: 25265772]

[20]
Engel ME, Haileamlak A, Zühlke L, et al. Prevalence of rheumatic heart disease in 4720 asymptomatic scholars from South Africa and Ethiopia. Heart  2015; 101(17): 1389-94.
 [http://dx.doi.org/10.1136/heartjnl-2015-307444] [PMID: 26076935]

[21]
Gemechu T, Mahmoud H, Parry EHO, Phillips DIW, Yacoub MH. Community-based prevalence study of rheumatic heart disease in rural Ethiopia. Eur J Prev Cardiol  2017; 24(7): 717-23.
 [http://dx.doi.org/10.1177/2047487316687104] [PMID: 28071960]

[22]
Beriye M, Araya F, Ahmed Y, et al. Feto-maternal complications and outcomes of pregnant women with valvular heart disease in a tertiary center in Ethiopia. PAMJ Clinical Medicine  2021; 6(5)
 [http://dx.doi.org/10.11604/pamj-cm.2021.6.5.28920]

[23]
Ahmed N, Kausar H, Ali L, Rakhshinda . Fetomaternal outcome of pregnancy with Mitral stenosis. Pak J Med Sci  2015; 31(3): 643-7.
 [PMID: 26150860]

[24]
Harper MA, Meyer RE, Berg CJ. Peripartum cardiomyopathy. Obstet Gynecol  2012; 120(5): 1013-9.
 [http://dx.doi.org/10.1097/AOG.0b013e31826e46a1] [PMID: 23090517]

[25]
Ng AT, Duan L, Win T, Spencer HT, Lee MS. Maternal and fetal outcomes in pregnant women with heart failure. Heart  2018; 104(23): 1949-54.
 [http://dx.doi.org/10.1136/heartjnl-2018-313156] [PMID: 29802180]

[26]
Goldstein SA, Ward CC. Congenital and acquired valvular heart disease in pregnancy. Curr Cardiol Rep  2017; 19(10): 96.
 [http://dx.doi.org/10.1007/s11886-017-0910-6] [PMID: 28840470]

[27]
Anthony J, Osman A, Sani MU. Valvular heart disease in pregnancy. Cardiovasc J Afr  2016; 27(2): 111-8.
 [http://dx.doi.org/10.5830/CVJA-2016-052] [PMID: 27213859]

[28]
Sharma Koirala P. Obstetric outcome in patients with rheumatic heart disease: experience of a tertiary hospital. Nepalese Heart Journal  2017; 14(2): 31-4.
 [http://dx.doi.org/10.3126/njh.v14i2.18500]

[29]
Diao M, Kane A, Ndiaye MB, et al. Pregnancy in women with heart disease in sub-Saharan Africa. Arch Cardiovasc Dis  2011; 104(6-7): 370-4.
 [http://dx.doi.org/10.1016/j.acvd.2011.04.001] [PMID: 21798468]

[30]
Siu SC, Colman JM, Sorensen S, Smallhorn SF, Amankwah KS, et al. Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac disease. Circulation  2002; 105: 2179-84.

[31]
Øyen N, Boyd HA, Carstensen L, Søndergaard L, Wohlfahrt J, Melbye M. Risk of congenital heart defects in offspring of affected mothers and fathers. Circ Genom Precis Med  2022; 15(4): e003533.
 [http://dx.doi.org/10.1161/CIRCGEN.121.003533] [PMID: 35608601]

[32]
Romano-Zelekha O, Hirsh R, Blieden L, Green MS, Shohat T. The risk for congenital heart defects in offspring of individuals with congenital heart defects. Clin Genet  2001; 59(5): 325-9.
 [http://dx.doi.org/10.1034/j.1399-0004.2001.590505.x] [PMID: 11359463]

[33]
Ramlakhan KP, Johnson MR, Roos-Hesselink JW. Pregnancy and cardiovascular disease. Nat Rev Cardiol  2020; 17(11): 718-31.
 [http://dx.doi.org/10.1038/s41569-020-0390-z] [PMID: 32518358]

[34]
Pieper PG. Pre-pregnancy risk assessment and counselling of the cardiac patient. Neth Heart J  2011; 19(11): 477-81.
 [http://dx.doi.org/10.1007/s12471-011-0188-z] [PMID: 21901506]

[35]
Drenthen W, Pieper PG, Roos-Hesselink JW, et al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol  2007; 49(24): 2303-11.
 [http://dx.doi.org/10.1016/j.jacc.2007.03.027] [PMID: 17572244]

[36]
Sm SCS, Sermer M, Harrison DA, et al. Risk and predictors for pregnancy-related complications in women with heart disease. Circulation  1997; 96(9): 2789-94.
 [http://dx.doi.org/10.1161/01.CIR.96.9.2789] [PMID: 9386139]

[37]
Lima FV, koutrolou-sotiropoulou P, Parikh PB, Avila C, Butler J, Stergiopoulos K. Pregnant women with heart disease: Placental characteristics and their association with fetal adverse events. Acute card care  2016; 18(3): 56-64.
 [http://dx.doi.org/10.1080/17482941.2017.1397699]

[38]
Regitz-zagrosek V, Roos-hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur heart j  2018; 39: 3165-241.

[39]
Magun E, DeFilippis EM, Noble S, et al. Cardiovascular Care for Pregnant Women With Cardiovascular Disease. J Am Coll Cardiol  2020; 76(18): 2102-13.
 [http://dx.doi.org/10.1016/j.jacc.2020.08.071] [PMID: 33121718]

[40]
van Hagen IM, Roos-Hesselink JW. Pregnancy in congenital heart disease: risk prediction and counselling. Heart  2020; 106(23): 1853-61.
 [http://dx.doi.org/10.1136/heartjnl-2019-314702] [PMID: 32611675]

[41]
Hameed A, Karaalp IS, Tummala PP, et al. The effect of valvular heart disease on maternal and fetal outcome of pregnancy. J Am Coll Cardiol  2001; 37(3): 893-9.
 [http://dx.doi.org/10.1016/S0735-1097(00)01198-0] [PMID: 11693767]

[42]
Makgato C, Baloyi S, Nondabula T. Profile of cardiac patients who delivered at Universitas Academic Hospital (UAH) in Bloemfontein South Africa: 2012-2017. Obstetr Gynaecol Forum  2020; 30(2): 1-10.

[43]
Paudyal P, Rawal S. Fate of pregnancy in women with rheumatic heart disease attending a tertiary referral centres. JNDA  2017; 7(2): 24-8.

[44]
Hink E, Bolte AC. Pregnancy outcomes in women with heart disease: Experience of a tertiary center in the Netherlands. Pregnancy Hypertens  2015; 5(2): 165-70.
 [http://dx.doi.org/10.1016/j.preghy.2014.12.001] [PMID: 25943639]

[45]
Bashir H. Fetomaternal outcome in mild to moderate mitral stenosis. Pak J Med Health Sci  2016; 10(4): 1348-52.

[46]
subbaiah M, Sharma V, kumar S, et al. Heart disease in pregnancy: cardiac and obstetric outcomes. Arch Gynecol Obstet  2013; 288(1): 23-7.
 [http://dx.doi.org/10.1007/s00404-013-2730-2] [PMID: 23377177]

[47]
Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J  2011; 32(24): 3147-97.
 [http://dx.doi.org/10.1093/eurheartj/ehr218] [PMID: 21873418]

[48]
Ngowa JDK, Kengne CGF, Nsahlai C, et al. Maternal and perinatal outcomes of pregnant women with heart disease in three yaoundé referral hospitals. Open J Obstet Gynecol  2022; 12(1): 93-103.
 [http://dx.doi.org/10.4236/ojog.2022.121009]

[49]
Fathy FT, Gonied AS, Mohammed NS. Maternal and neonatal outcome in women with cardiac diseases and suggested nursing guidelines. J Nurs Health Sci  2018; 7(2): 80-91.

[50]
Wasim T, Amer W, Majrroh A, Siddiq S. Foetomaternal outcome of pregnancy with cardiac disease. J Pak Med Assoc  2008; 58(4): 175-8.
 [PMID: 18655424]

[51]
Pieper PG, Balci A, Aarnoudse JG, et al. Investigators zi. Uteroplacental blood flow, cardiac function, and pregnancy outcome in women with congenital heart disease. Circulation  2013; 128: 2478-8.

[52]
Javaid A, Majid A, Aslam S, et al. maternal and fetal outcome of pregnant patients having preexisting cardiovascular disease. Cureus  2020; 12(8): e9563.
 [http://dx.doi.org/10.7759/cureus.9563] [PMID: 32905531]

[53]
Drenthen W, Boersma E, Balci A, et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J  2010; 31(17): 2124-32.
 [http://dx.doi.org/10.1093/eurheartj/ehq200] [PMID: 20584777]

[54]
Lipczyńska M, Janisz K, Szymański P, et al. Pregnancy-related cardiac non-elective hospitalizations and pregnancy outcomes. A tertiary referral cardiac center experience. Kardiol Pol  2021; 79(7-8): 789-95.
 [http://dx.doi.org/10.33963/KP.15985] [PMID: 33926168]

[55]
Liu Y, Li Y, Zhang J, et al. Pregnancy Complications and Outcomes Among Women With Congenital Heart Disease in Beijing, China. Front Cardiovasc Med  2022; 8: 765004.
 [http://dx.doi.org/10.3389/fcvm.2021.765004]

[56]
Ducas R, Saini BS, Yamamura K, et al. Maternal and fetal hemodynamic adaptations to pregnancy and clinical outcomes in maternal cardiac disease. Can J Cardiol  2021; 37(12): 1942-50.
 [http://dx.doi.org/10.1016/j.cjca.2021.06.015] [PMID: 34224828]

[57]
Ramage K, Grabowska K, Silversides C, Quan H, Metcalfe A. Association of adult congenital heart disease with pregnancy, maternal, and neonatal outcomes. JAMA Netw Open  2019; 2(5): e193667.
 [http://dx.doi.org/10.1001/jamanetworkopen.2019.3667] [PMID: 31074818]

[58]
Khairy P, Ouyang DW, Fernandes SM, Lee-Parritz A, Economy KE, Landzberg MJ. Pregnancy outcomes in women with congenital heart disease. Circulation  2006; 113(4): 517-24.
 [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.589655] [PMID: 16449731]

[59]
Elliott C, Sliwa K, Anthony J. Perinatal outcome in pregnant women with heart disease attending a combined obstetric and cardiology clinic in a resource limited country. Int J Gynecol, Obst Neonat Care  2015; 2(2): 8-15.
 [http://dx.doi.org/10.15379/2408-9761.2015.02.02.02]

[60]
Rahayu AP, Gumilar KE. Pregnancy and Delivery with Cardiac Disease in Dr. Soetomo Hospital 2018. Int Islamic Med J  2021; 2(2): 61-6.
 [http://dx.doi.org/10.33086/iimj.v2i2.1822]

[61]
Anon. . ACOG Practice Bulletin No. 212: Pregnancy and heart disease. Obstet Gynecol  2019; 133(5): e320-56.
 [http://dx.doi.org/10.1097/AOG.0000000000003243] [PMID: 31022123]

[62]
Barrett ML, Jiang HJ, Bailey MK, Weiss AJ. Characteristics of 30-day all-cause hospital readmissions, 2010–2016 #248. Healthc. Cost Util. Proj. 2019. Available from: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb248-Hospital-Readmissions-2010–2016.jsp (Accessed on: 23/10/2022).