Article Text
Abstract
Objective Women with congenital heart disease (CHD) are at risk for adverse cardiac events during pregnancy; however, the risk of events late after pregnancy (late cardiac events; LCE) has not been well studied. A study was undertaken to examine the frequency and determinants of LCE in a large cohort of women with CHD.
Design Baseline characteristics and pregnancy were prospectively recorded. LCE (>6 months after delivery) were determined by chart review. Survival analysis was used to determine the risk factors for LCE.
Setting A tertiary care referral hospital.
Patients The outcomes of 405 pregnancies were studied (318 women; median follow-up 2.6 years).
Main outcome measures LCE included cardiac death/arrest, pulmonary oedema, arrhythmia or stroke.
Results LCE occurred after 12% (50/405) of pregnancies. The 5-year rate of LCE was higher in women with adverse cardiac events during pregnancy than in those without (27±9% vs 15±3%, HR 2.2, p=0.02). Women at highest risk for LCE were those with functional limitations/cyanosis (HR 3.9, 95% CI 1.2 to 13.0), subaortic ventricular dysfunction (HR 3.0, 95% CI 1.4 to 6.6), subpulmonary ventricular dysfunction and/or significant pulmonary regurgitation (HR 3.2, 95% CI 1.6 to 6.6), left heart obstruction (HR 2.6, 95% CI 1.2 to 5.2) and cardiac events before or during pregnancy (HR 2.6, 95% CI 1.3 to 4.9). In women with 0, 1 or >1 risk predictors the 5-year rate of LCE was 7±2%, 23±5% and 44±10%, respectively (p<0.001).
Conclusions In women with CHD, pre-pregnancy maternal characteristics can help to identify women at increased risk for LCE. Adverse cardiac events during pregnancy are important and are associated with an increased risk of LCE.
- Pregnancy
- congenital heart disease
- outcomes
- epidemiology
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Footnotes
Funding This work is supported by operating grants from Heart and Stroke Foundation of Canada (NA 5927, NA 5662) and Canadian Institutes of Health Research (53030, 93722). SCSis supported by the Ramsay Gunton Professorship in Cardiology of the Schulich School of Medicine and Dentistry, University of Western Ontario. The University of Toronto Pregnancy and Heart Disease Research Program acknowledges a generous donation from Mrs Josephine Rogers.
Competing interests None.
Ethics approval This study was conducted with the approval of the University Health Network and Mount Sinai Hospital, Toronto, Canada and all subjects gave informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.