Pregnancy outcomes in women with heart disease: the Madras Medical College Pregnancy And Cardiac (M-PAC) Registry from India
Author:
Justin Paul Gnanaraj1ORCID, Anne Princy Steaphen2ORCID, Anju Surendran1ORCID, Anita Susikar3, Cecily Mary Majella2, Gnanavelu Ganesan1, Kanmani Kandasamy3, Meena Mahalingam3, Nandakumaran Mohanan4, Ramya Swaminathan5, Ravishankar Govindarajulu1, Shaanthi Gunasingh5, Shoba Somasundaram5, Sangareddi Venkatesan1, Vijaya Subramanian5, Gomathy , Geetha , Rani Usha, Selvi N Tamil, Sarala , Selvi B Tamil, Elizabeth Prema, Nalina , Priyadarsene , Kasthuri , Sadhana , Sindhumathy , Sudarshini , Nazreeen , Devika , Sivakumar Shoba, Umarani C, Priya R, Kaleeswari , Suganya , Shunmugam Ravi Marimuthu, Ganapathy Palaniswamy, Chandran Moorthy, Nagarajan Swaminathan, Ganesan Manohar, Angappamudali Arumugam Moongilpatti, Jeyabalan Nambirajan, Palani Balaji Pandian, Saravanababu , Srinivasan Kumaran, Elangovan Elavarasi Manimegalai, Mohandoss Nageswaran Piskala, Chandrasekaran Elangovan, Duraipandian Rajasekar Ramesh, Gorijavaram Pratap Kumar, Kunjjitham Tamilselvan, Ravindran , Dharmarajan , Kaliyamurthy Thiagarajan, Sreeram Jeyalaxmi, Seeralan Arasar, Mangalabharathi , Mariappan Baliah, Manimaran Chandrika, kumar Ebenezer Joel,
Affiliation:
1. Institute of Cardiology, Rajiv Gandhi Government General Hospital, Madras Medical College , Parktown, Chennai 600003, Tamil Nadu , India 2. Department of Cardiology, Tamil Nadu Government Multi Super-Speciality Hospital , Omandurar Government Estate, Anna Salai, Chennai 600002, Tamil Nadu , India 3. Department of Obstetrics and Gynecology, Kasturba Gandhi Hospital for Women and Children, Madras Medical College , Bell's Road, Triplicane, Chennai 600005, Tamil Nadu , India 4. Department of Cardiology, Kilpauk Medical College, No-149, Poonamalee High Road , Kilpauk, Chennai 600010, Tamil Nadu , India 5. Institute of Obstetrics and Gynecology, No-2, Pantheon Road , Egmore, Chennai 600008, Tamil Nadu , India
Abstract
Abstract
Aims
To evaluate the feto-maternal outcome, identify the adverse outcome predictors and test the applicability of modified WHO (mWHO) classification in pregnant women with heart disease (PWWHD) from Tamil Nadu, India.
Methods and results
One thousand and five pregnant women (mean age: 26.04 ± 4.2) with 1029 consecutive pregnancies were prospectively enrolled from July 2016 to December 2019 in the Madras medical college pregnancy and cardiac (M-PAC) registry. Majority (60.5%; 623/1029) had heart disease (HD) diagnosed for the first time during pregnancy. Rheumatic HD (42%; 433/1029) was most common. One third (34.2%; 352/1029) had pulmonary hypertension (PH). Maternal mortality and composite maternal cardiac events (MCEs) were the primary outcomes. Secondary outcomes were foetal loss and composite adverse foetal events (AFEs). MCEs occurred in 15.2% (156/1029; 95% CI: 13.0–17.5) pregnancies. Heart failure was the most common MCE (66.0%; 103/156; 95% CI: 58.0–73.4). Maternal mortality was 1.9% (20/1029; 95% CI: 1.1–2.8), with highest rates in patients with prosthetic heart valves (PHVs) (8.6%; 6/70). Left ventricular systolic dysfunction (LVSD), PHVs, severe mitral stenosis, PH and current pregnancy diagnosis of HD were independent predictors of MCE. The c-statistic of mWHO classification for predicting MCE and maternal death were 0.794 (95% CI: 0.763–0.826) and 0.796 (95% CI: 0.732–0.860). 91.2% (938/1029; 95% CI: 89.392.8) of pregnancies resulted in live births. 33.7% (347/1029; 95% CI: 30.8–36.7) of pregnancies reported AFEs.
Conclusion
Maternal mortality is high in PWWHD from India. Highest death rates occurred in women with PHVs, PH and LVSD. The mWHO classification for risk stratification may require further adaptation and validation in India.
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine
Cited by
9 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献
|
|