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Cardiovascular Care for Pregnant Women With Cardiovascular Disease
Ella Magun1, Ersilia M DeFilippis1, Sarah Noble1
1Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
Insights
Cardio-obstetrics care for pregnant women with cardiovascular disease (CVD) showed encouraging maternal outcomes and low readmission rates. This multidisciplinary approach improves care for high-risk pregnancies.
Area of Science:
- Cardiology
- Obstetrics
- Maternal-Fetal Medicine
Background:
- Cardio-obstetrics involves multidisciplinary collaboration for maternal care.
- Focuses on pregnant women with underlying cardiovascular disease (CVD).
Purpose of the Study:
- Describe clinical characteristics of pregnant women with CVD.
- Evaluate maternal and fetal outcomes.
- Assess cardiovascular readmission rates in this cohort.
Main Methods:
- Retrospective cohort study of 306 pregnant women with CVD.
- Data collected from January 2010 to December 2019.
- Utilized the Cardiac Disease in Pregnancy (CARPREG) II score.
Main Results:
- Most women were insured by Medicaid; common CVDs included arrhythmia, congenital heart disease, and cardiomyopathy.
- Low rates of gestational diabetes, hypertension, and preeclampsia observed.
- Low 30-day (2%) and 30-90 day (4.6%) postpartum readmission rates; 98% live birth rate.
Conclusions:
- Cardio-obstetrics team management in a Medicaid-insured population yielded positive maternal outcomes and low readmissions.
- Further prospective studies are recommended to confirm the impact of cardio-obstetric models on maternal health.
Background:
Cardio-obstetrics refers to a team-based approach to maternal care that includes multidisciplinary collaboration among maternal fetal medicine, cardiology, and others.
Objectives:
This study sought to describe clinical characteristics, maternal and fetal outcomes, and cardiovascular readmissions in a cohort of pregnant women with underlying cardiovascular disease (CVD) followed by a cardio-obstetrics team.
Methods:
We identified patients evaluated by our cardio-obstetrics team from January 1, 2010, through December 31, 2019, at a quaternary care hospital in New York City. Information was collected regarding demographics, comorbidities, underlying CVD, medications, maternal and fetal outcomes, and cardiovascular readmissions. Each patient was assigned a Cardiac Disease in Pregnancy (CARPREG) II score based on her clinical characteristics and underlying CVD.
Results:
During the study period, 306 pregnant women (median age 29 years, 52.9% Hispanic or Latino) with CVD were seen. Most women (74.2%) were insured through Medicaid. The most common forms of CVD included arrhythmia (n = 88, 28.8%), congenital heart disease (n = 72, 23.5%), and cardiomyopathy (n = 72, 23.5%). The median CARPREG II score was 3; 130 patients (42.5%) had a CARPREG II score ≥4. Gestational diabetes occurred in 11.4%, gestational hypertension in 9.5%, and preeclampsia in 12.1% of women. Intensive care unit admission was required for 27 patients (8.8%) during delivery. Median gestational age for delivery was 38 weeks (interquartile range: 37 to 39). Live birth occurred in 98% of pregnancies. One maternal death occurred within a year of delivery in a woman with Eisenmenger syndrome. Following delivery, 30-day readmission rate was 2% and the rate of readmission from 30 to 90 days postpartum was 4.6%. Median follow-up was 2.6 years.
Conclusions:
In a population of primarily Medicaid-insured pregnant women managed by a cardio-obstetrics team, maternal outcomes were encouraging and readmission rates following delivery were low. Prospective studies are needed to evaluate the impact of cardio-obstetric models of care on maternal outcomes.
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