Faculty Collaboration Database

Cardiovascular and Obstetric Delivery Complications in Pregnant Women With Valvular Heart Disease. Am J Cardiol 2021 Nov 01;158:90-97

Date

08/29/2021

Pubmed ID

34452683

Pubmed Central ID

PMC8765669

DOI

10.1016/j.amjcard.2021.07.038

Scopus ID

2-s2.0-85113604503 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

Women with valvular heart disease may be more likely to have adverse obstetric and cardiovascular complications during pregnancy. Most current recommendations focus on stenotic lesions with less guidance regarding regurgitant lesions. We aimed to compare adverse events at delivery for women with various stenotic and regurgitant valvular diseases. We used the 2016 to 2018 National Inpatient Sample data to compare demographics, comorbidities, and obstetric and cardiovascular complications during delivery hospitalizations. After adjusting for clinical and socioeconomic factors, logistic regression was performed to investigate associations between valvular disease and outcomes. Among >11.2 million deliveries, 20,349 were in women with valvular disease. Women with valvular disease were older, had longer length of stays, and higher costs associated with delivery. They had higher prevalence of underlying cardiovascular comorbidities compared with women without valvular disease (hypertension: 5.1 vs 0.25%; pulmonary hypertension: 7.0 vs <0.1%). At delivery, they had higher adjusted odds of obstetric events including preeclampsia and/or eclampsia (aOR 1.9 [1.8 to 2.2]) and intrapartum/postpartum hemorrhage (aOR 1.4 [1.2 to 1.6]), and cardiovascular events including peripartum cardiomyopathy (aOR 65 [53 to 78]), pulmonary edema (aOR 17 [13 to 22]), acute ischemic heart disease (aOR 19 [12 to 30]) and arrhythmias (aOR 22 [19 to 27]). There were valve lesion-specific differences in the magnitude of risk but both stenotic and regurgitant lesions were associated with elevated risk of cardiovascular complications. In conclusion, pregnant women with stenotic and regurgitant valvular disease have a greater burden of cardiovascular comorbidities and increased odds of obstetric and cardiovascular events at delivery. These women may benefit from specialized care from a Cardio-Obstetrics team.

Author List

Minhas AS, Rahman F, Gavin N, Cedars A, Vaught AJ, Zakaria S, Resar J, Schena S, Schulman S, Zhao D, Hays AG, Michos ED

Author

Stefano Schena MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Cohort Studies
Female
Heart Valve Diseases
Hospitalization
Humans
Logistic Models
Obstetric Labor Complications
Odds Ratio
Pregnancy
Pregnancy Complications, Cardiovascular
Risk Factors
Young Adult