Maternal heart disease and pregnancy outcome: A single-centre experience

doi:10.1016/j.ejheart.2008.07.017

European Journal of Heart Failure 2008 10(9):855-860; doi:10.1016/j.ejheart.2008.07.017

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Maternal heart disease and pregnancy outcome: A single-centre experience

Verena Stangl^a^,*, Johanna Schad^a, Gabriele Gossing^b, Adrian Borges^a, Gert Baumann^a and Karl Stangl^a

^a Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie Charitéplatz 1, D-10117 Berlin, Germany
^b Klinik für Geburtsmedizin Universitätsmedizin Berlin Charité Campus Mitte, Germany

^* Corresponding author. Tel.: +49 30 450 513 153; fax: +49 30 450 513 932. E-mail address: verena.stangl{at}charite.de (V. Stangl).

Abstract

Background: Maternal and neonatal complication rates are increased in pregnantwomen with heart disease. Cardiac risk assessment may be improvedby defining low and high-risk groups.

Aims: To analyze pregnancy risks in low and high-risk women with cardiovasculardiseases.

Methods and results: Pregnancy outcomes were analyzed in 93 consecutive women withheart disease, monitored in a single-centre cohort between 1996and 2006. Women were classified according to pre-defined riskpredictors as high-risk (left ventricular [LV] ejection fraction<50%, NYHA class>II or cyanosis, peak LV outflow gradient>60 mmHg) or low-risk (not meeting these criteria). Meanage was 28.1±5.7 years. 81.7% presented with congenital,10.8% with acquired heart disease, and 7.5% with myocardialdiseases. Severe maternal complications developed in 12.9% ofall women: 6.5% heart failure, 3.2% arrhythmias, and 2.2% thromboticcomplications. Maternal mortality was 1.1%. Women at high-risk(24.7%) had a 6.1-fold higher maternal complication rate anda 6.1 times higher foetal/neonatal event rate (abortion andstillbirth). 64.7% of the high-risk women delivered prematurely,before the 37th week, compared to 16.4% in the low-risk group.

Conclusions: Despite pronounced clinical variability of congenital and acquiredheart diseases, a small number of risk conditions can effectivelycharacterize women in whom pregnancy is associated with appreciablyincreased maternal and foetal risk.

Key Words: Pregnancy • Heart disease • Maternal • Foetal • Risk

Received February 11, 2008; Revised June 30, 2008; Accepted July 24, 2008

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