Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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n = 141 | |
Personal history | |
Smoking, n, % | 13 (9.2%) |
Diabetes mellitus, n, % | 3 (2.1%) |
Chronic hypertension, n, % | 5 (3.5%) |
Stroke, n, % | 2 (1.4%) |
Heart failure, n, % | 11 (7.8%) |
Cardiovascular surgeries, n, % | 36 (25.5%) |
Pre-pregnancy cardiovascular medication | 34 (24.1%) |
Known heart disease, n, % | 105 (74.5%) |
In vitro fertilization, n, % | 13 (9.2%) |
Basal cardiological characteristics | |
Pre-pregnancy consultation with cardiologist, n, % | 21 (14.8%) |
Type of heart disease, n, %: | |
Congenital heart disease | 53 (37.5%) |
Cardiomyopathy | 16 (11.3%) |
Ischemic heart disease | 2 (1.4%) |
Marfan syndrome | 2 (1.4%) |
Valve disease | 35 (24.8%) |
Rheumatic valve disease | 9 (6.3%) |
Valve prosthesis | 6 (4.3%) |
Arrhythmia | 46 (32.6%) |
Arrhythmia device | 4 (2.9%) |
Basal echocardiographic parameters, n, %: | |
Systemic ventricle ejection dysfunction (SVEF) < 55% | 13 (9.2%) |
Systemic ventricle dilatation | 13 (9.2%) |
Sub-pulmonary ventricle dysfunction | 10 (7.09%) |
Ascending aortic dilatation | 6 (4.4%) |
Systemic ventricle outflow tract obstruction | 7 (5.0%) |
Pulmonary hypertension | 2 (1.4%) |
Valvular insufficiency (moderate or severe) | 22 (15.6%) |
New York Heart Association (NYHA) functional classification, n, %: | |
I | 123 (87.2%) |
II | 18 (12.8%) |
Modified World Health Organization (mWHO) classification, n, %: | |
I | 34 (24.1%) |
II | 48 (34.0%) |
II–III | 36 (25.5%) |
III | 20 (14.2%) |
IV | 3 (2.1%) |
n = 141 | |
Use of CV medication during current pregnancy n, % | 47 (33.3%) |
Cardiovascular complications | 32/141 (22.6%) |
Deterioration of NYHA functional class, n, % | 24 (17.0%) |
MACEs (major maternal CV events), n, % | 28/141 (19.9%) |
Heart failure, n, % | 15 (10.6%) |
Peripartum cardiomyopathy, n, % | 7 (4.9%) |
Acute pulmonary oedema, n, % | 5 (3.6%) |
Thromboembolic complication, n, % | 1 (0.7%) |
Arrhythmic complication, n, % | 12 (8.6%) |
Cardiac surgery during pregnancy, n, % | 2 (1.6%) |
Hospital admission due to cardiovascular complication, n, % | 15 (10.6%) |
Maternal admission to the intensive care unit (ICU), n, % | 7 (5.0%) |
Duration of ICU admission (days) (n = 7), mean ± SD | 7.7 ± 7.1 |
Maternal Death, n, % | 0 (0%) |
n = 132 | |
Obstetric complications | 32/132 (24.2%) |
Stillbirth, n, % | 1 (0.7%) |
Threatened preterm labor, n, % | 3 (2.3%) |
Gestational hypertensive disorder, n, % | 13 (9.8%) |
Preeclampsia, n, % | 9 (6.8%) |
Fetal macrosomia n, % | 2 (1.6%) |
Oligohydramnios, n, % | 9 (7.2%) |
Intrauterine growth restriction (IUGR), n, % | 9 (7.9%) |
Hospital admission for obstetric reasons (other than delivery), n, % | 5 (3.8%) |
Postpartum hemorrhage, n, % | 4 (3.2%) |
Other obstetric variables | |
Cardiovascular cause for C-section, n, % | 7 (14.6%) |
Obstetric cause for C-section, n, % | 36 (75%) |
Both CV and obstetric cause for C-section, n, % | 5 (10.4%) |
No breastfeeding, n, % | 10 (7.6%) |
n = 136 | |
Neonatal complications | 38/136 (27.9%) |
Congenital heart disease, n, % | 18 (13.2%) |
Neonatal admission, n, % | 20 (14.7%) |
Duration of neonatal admission (days) (n = 20), mean ± SD | 6.5 ± 7.0 |
Neonatal intensive care unit admission, n, % | 4 (3.1%) |
Duration of neonatal intensive care unit admission (n = 4), mean ± SD | 5 ± 3.27 |
Total | Cases | Controls | p Value | |
---|---|---|---|---|
n = 396 | n = 132 | n = 264 | ||
Maternal Characteristics | ||||
Nulliparity, n, % | 223 (56.3%) | 73 (55.3%) | 150 (56.8%) | 0.8 2 |
Twin pregnancy, n, % | 12 (3.0%) | 4 (3.0%) | 8 (3.0%) | >0.9 2 |
Maternal age (years), mean, SD | 32.71 ± 5.84 | 33.17 ± 5.51 | 32.49 ± 5.99 | 0.3 2 |
Maternal age < 20 years | 9 (2.3%) | 2 (1.5%) | 7 (2.7%) | 0.5 2 |
Maternal age 20–35 years | 252 (63.6%) | 82 (62.1%) | 170 (64.3%) | 0.7 2 |
Maternal age 36–39 years | 98 (24.7%) | 33 (25.0%) | 65 (24.6%) | >0.9 2 |
Maternal age > 40 years | 37 (9.3%) | 15 (11.3%) | 22 (8.3%) | 0.3 2 |
Delivery results | ||||
Onset of labor, n, %: | ||||
Spontaneous | 242 (61.1%) | 60 (45.5%) | 182 (68.9%) | <0.001 2 |
Induction | 100 (25.3%) | 41 (31.1%) | 59 (22.3%) | 0.057 2 |
Type of anesthesia, n, %: | ||||
None | 26 (6.6%) | 6 (4.7%) | 20 (7.6%) | 0.3 2 |
Local | 21 (5.4%) | 3 (2.3%) | 18 (6.8%) | 0.048 2 |
Rachidial | 45 (11.4%) | 23 (17.4%) | 22 (8.3%) | 0.006 2 |
Epidural | 288 (72.7%) | 86 (65.1%) | 202 (76.5%) | 0.052 2 |
General | 12 (3.1%) | 10 (7.8%) | 2 (0.8%) | <0.001 2 |
Type of delivery, n, %: | ||||
Total C-sections | 97 (24.5%) | 49 (37.1%) | 48 (18.2%) | <0.001 2 |
Unplanned C-sections | 44 (11.1%) | 19 (14.4%) | 25 (9.5%) | 0.917 |
Scheduled C-section | 53 (13.4%) | 30 (22.7%) | 23 (8.7%) | <0.001 2 |
Total vaginal deliveries | 298 (75.3%) | 82 (62.1%) | 216 (81.8%) | <0.001 2 |
Eutocic vaginal delivery | 234 (59.1%) | 59 (44.7%) | 175 (66.3%) | <0.001 2 |
Assisted vaginal delivery | 64 (16.2%) | 23 (17.4%) | 41 (15.5%) | 0.6 2 |
Postpartum maternal admission (days), mean ± SD | 2.81 ± 2.44 | 3.49 ± 2.67 | 2.50 ± 2.26 | <0.001 2 |
Postpartum maternal admission ≥ 7 days, n, % | 15 (3.9%) | 9 (7.2%) | 6 (2.3%) | 0.025 2 |
Neonatal results | n = 408 | n = 136 | n = 272 | |
Male, n, % | 201 (49.3%) | 76 (55.9%) | 125 (46.0%) | 0.034 2 |
Gestational age (GA), mean ± SD | 38.52 ± 2.32 | 38.23 ± 2.10 | 38.66 ± 2.41 | 0.095 2 |
GA < 37 weeks | 41 (10.0%) | 18 (13.2%) | 23 (8.5%) | 0.14 2 |
GA < 34 weeks | 13 (3.2%) | 5 (3.6%) | 8 (2.9%) | 0.7 2 |
GA < 32 weeks | 7 (1.7%) | 1 (0.7%) | 6 (2.2%) | 0.2 2 |
Weight (grams), mean ± SD | 3101.87 ± 600.84 | 3012.40 ± 595.95 | 3146.77 ± 599.35 | 0.035 2 |
Weight < 2.500 g, n, % | 53 (13.0%) | 25 (18.3%) | 28 (10.3%) | 0.026 2 |
Weight percentile, n, % | 50.57 ± 31.54 | 46.62 ± 31.54 | 52.51 ± 31.42 | 0.078 2 |
Weight < 10th percentile, n, % | 48 (11.8%) | 20 (14.7%) | 28 (10.3%) | 0.2 2 |
Neonatal reanimation, n, % | ||||
None | 315 (77.2%) | 99 (72.8%) | 216 (79.4%) | 0.6 2 |
Aspiration of nasopharyngeal secretions | 14 (3.4%) | 4 (2.9%) | 10 (3.7%) | 0.8 2 |
Oxygen therapy | 15 (3.7%) | 4 (2.9%) | 11 (4.0%) | 0.6 2 |
Positive pressure ventilation | 32 (7.8%) | 13 (9.6%) | 19 (6.9%) | 0.3 2 |
Invasive ventilation | 8 (1.9%) | 2 (1.5%) | 6 (2.2%) | 0.7 2 |
Apgar test 1st minute, mean ± SD | 8.54 ± 1.27 | 8.35 ± 1.45 | 8.63 ± 1.17 | 0.043 2 |
Apgar test 1st minute < 7, n, % | 28 (6.9%) | 12 (9.0%) | 16 (5.9%) | 0.3 2 |
Apgar test 5th minute, mean ± SD | 9.51 ± 1.00 | 9.37 ± 1.20 | 9.58 ± 0.88 | 0.05 2 |
Apgar test 5th minute < 7, n, % | 4 (1.0%) | 2 (1.5%) | 2 (0.7%) | 0.5 2 |
Arterial Ph umbilical cord, mean ± SD | 7.28 ± 0.08 | 7.28 ± 0.08 | 7.28 ± 0.08 | 0.8 2 |
Arterial Ph umbilical cord < 7, n, % | 3 (0.8%) | 0 (0%) | 3 (1.1%) | 0.14 2 |
Neonatal death, n, % | 1 (0.2%) | 0 (0%) | 1 (0.4%) | 0.4 2 |
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Aracil Moreno, I.; Prieto-Arévalo, R.; Ortega-Abad, V.; Martín-Manzano, V.; Pérez-Burrel, L.; Fraile-López, A.; Devesa-Cordero, C.; Yllana-Pérez, F.; Ortega, M.A.; De León-Luis, J.A. Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study. J. Clin. Med. 2024, 13, 5084. https://doi.org/10.3390/jcm13175084
Aracil Moreno I, Prieto-Arévalo R, Ortega-Abad V, Martín-Manzano V, Pérez-Burrel L, Fraile-López A, Devesa-Cordero C, Yllana-Pérez F, Ortega MA, De León-Luis JA. Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study. Journal of Clinical Medicine. 2024; 13(17):5084. https://doi.org/10.3390/jcm13175084
Chicago/Turabian StyleAracil Moreno, Irene, Raquel Prieto-Arévalo, Virginia Ortega-Abad, Virginia Martín-Manzano, Laura Pérez-Burrel, Andrea Fraile-López, Carolina Devesa-Cordero, Fátima Yllana-Pérez, Miguel A. Ortega, and Juan A. De León-Luis. 2024. "Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study" Journal of Clinical Medicine 13, no. 17: 5084. https://doi.org/10.3390/jcm13175084