Management and outcomes of pregnant women with cardiovascular diseases in a cardio-obstetric team

Area of Science:

• Cardiology
• Obstetrics
• Maternal Health

Background:

• Cardiovascular diseases (CVDs) are the leading cause of maternal mortality in Western nations.
• Multidisciplinary cardio-obstetric teams are recommended for managing pregnant women with CVD, but supporting data is limited.

Purpose of the Study:

• To characterize pregnant patients with CVD managed in a tertiary center's cardio-obstetric program.
• To evaluate the outcomes of these high-risk pregnancies.

Main Methods:

• Retrospective analysis of 209 pregnancies in 202 patients with CVD managed by a cardio-obstetric team (June 2017-December 2019).
• Collection of major adverse cardiovascular events during pregnancy, peripartum, and 1-year follow-up.
• Assessment of CVD types, modified World Health Organization (mWHO) classification, and CARdiac disease in PREGnancy (CARPREG II) scores.

Main Results:

• Predominant CVDs included valvular heart disease (37.8%), rhythm disorders (26.8%), and adult congenital heart disease (22.5%).
• 47.4% had mWHO > II, and 66.5% had CARPREG II ≥ 2, indicating a high-risk population.
• Major cardiovascular events occurred in 7.7% of pregnancies during the study period and 1.5% during 1-year follow-up.
• Most events (63.1%) occurred in patients with previously unknown CVD.

Conclusions:

• Cardio-obstetric team management appears effective, yielding a low cardiovascular event rate in a high-risk pregnant population.
• The majority of cardiovascular events occurred in patients lacking prior cardiac monitoring, highlighting the importance of pre-pregnancy assessment.