Affiliation:
1. Division of Cardiovascular Medicine Department of Medicine State University of New York Stony Brook University Medical Center Stony Brook NY
2. Department of Family, Population and Preventive Medicine Stony Brook University Medical Center Stony Brook NY
3. Department of Applied Mathematics and Statistics Stony Brook University Stony Brook NY
4. Department of Medicine Brown University Rhode Island Hospital Providence RI
5. Department of Obstetrics, Gynecology and Reproductive Medicine University Medical Center Stony Brook NY
Abstract
Background
Pregnant women with underlying heart disease (
HD
) are at increased risk for adverse maternal, obstetric, and neonatal outcomes.
Methods and Results
Inpatient maternal delivery admissions and linked neonatal stays for women with cardiomyopathy, adult congenital HD, pulmonary hypertension (
PH
), and valvular HD were explored utilizing the Statewide Planning and Research Cooperative System (New York), January 1, 2000, through December 31, 2014, with the
International Classification of Diseases, Ninth Revision
,
Clinical Modification (ICD‐9‐CM)
. Maternal major adverse cardiac events, neonatal adverse clinical events (
NACE
), and obstetric complications were recorded. Outcomes were compared using multiple logistic regression modeling. Among 2 284 044 delivery admissions, 3871 women had
HD
; 676 (17%) had cardiomyopathy, 1528 (40%) had valvular HD, 1367 (35%) had adult congenital HD, and 300 (8%) had
PH
. Major adverse cardiac events occurred in 16.1% of women with
HD
, with most in the cardiomyopathy (45.9%) and
PH
(25%) groups.
NACE
was more common in offspring of women with
HD
(18.4% versus 7.1%), with most in the cardiomyopathy (30.0%) and
PH
(25.0%) groups. Increased risk of
NACE
was noted for women with
HD
(odds ratio [
OR
]: 2.8; 95% confidence interval [
CI
], 2.5–3.0), with the highest risk for those with cardiomyopathy (
OR
: 5.9; 95%
CI
, 5.0–7.0) and
PH
(
OR
: 4.5; 95%
CI
, 3.4–5.9). Preeclampsia (
OR
: 5.1; 95%
CI
, 3.0–8.6), major adverse cardiac events (
OR
: 2.3; 95%
CI
, 1.8–2.9), preexisting diabetes mellitus (
OR
: 4.3; 95%
CI
, 1.5–12.3), and obstetric complications (
OR
: 2.9; 95%
CI
, 1.7–5.2) were independently associated with higher
NACE
risk.
Conclusions
Neonatal complications were higher in offspring of pregnant women with
HD
, particularly cardiomyopathy and
PH
. Preeclampsia, major adverse cardiac events, obstetric complications, and preexisting diabetes mellitus were independently associated with a higher risk of
NACE
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
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