Karen Sliwa1, Lucia Baris2, Christoph Sinning3, Elvin Zengin-Sahm3, Lina Gumbiene4, Israa F Yaseen5, Ghada Youssef6, Mark Johnson7, Hasan Al-Farhan5, Malgorzata Lelonek8, Roger Hall9, Jolien Roos-Hesselink10. 1. Department of Cardiology and Medicine, Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. 2. Erasmus Medical Center, Rotterdam, the Netherlands. 3. Department of General and Interventional Cardiology, University Medical Centre, Hamburg, Germany. 4. Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. 5. Baghdad Heart Center, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq. 6. Cardiology Department, Kasr Al Ainy Hospitals, Faculty of Medicine, Cairo University, Cairo, Egypt. 7. Imperial College London, London, United Kingdom. 8. Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland. 9. Norfolk and Norwich University Hospitals, Norwich, United Kingdom. 10. Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: j.roos@erasmusmc.nl.
Abstract
OBJECTIVES: The purpose of this work was to study maternal and fetal outcomes of women with uncorrected congenital heart disease (CHD). BACKGROUND: Globally, CHD is an important cause of maternal morbidity and mortality in women reaching reproductive stage. Data are lacking from larger cohorts of women with uncorrected CHD. METHODS: The 10-year data from the European Society of Cardiology EORP ROPAC (EURObservational Research Programme Registry of Pregnancy and Cardiac disease) registry of women with uncorrected CHD were analyzed. RESULTS: Of 5,739 pregnancies in 53 countries, 3,295 women had CHD, 1,059 of which were uncorrected cases. Of these, 41.4% were from emerging countries. There were marked differences between the cardiac defects in uncorrected cases versus those in corrected CHD cases with primary shunt lesions (44.7% vs. 32.4%, respectively), valvular abnormalities (33.5% vs. 12.6%, respectively), and Tetralogy of Fallot and pulmonary atresia (0.8% vs. 20.3%, respectively; p < 0.001). In patients with uncorrected CHD, 6.8% were in modified World Health Organization risk class IV, approximately 10% had pulmonary hypertension (PH), and 3% were cyanotic prior to pregnancy. Maternal mortality and heart failure (HF) in the women with uncorrected CHD were 0.7% and 8.7%, respectively. Eisenmenger syndrome was associated with a very high risk of cardiac events (65.5%), maternal mortality (10.3%), and HF (48.3%). Coming from an emerging country was associated with higher pre-pregnancy signs of HF, PH, and cyanosis (p < 0.001) and worse maternal and fetal outcomes, with a 3-fold higher rate of hospital admissions for cardiac events and intrauterine growth retardation (p < 0.001). CONCLUSIONS: Marked differences between cardiac conditions in pregnant women with uncorrected CHD and those in corrected CHD were found, with a markedly worse outcome, particularly in women with Eisenmenger syndrome and from emerging countries.
OBJECTIVES: The purpose of this work was to study maternal and fetal outcomes of women with uncorrected congenital heart disease (CHD). BACKGROUND: Globally, CHD is an important cause of maternal morbidity and mortality in women reaching reproductive stage. Data are lacking from larger cohorts of women with uncorrected CHD. METHODS: The 10-year data from the European Society of Cardiology EORP ROPAC (EURObservational Research Programme Registry of Pregnancy and Cardiac disease) registry of women with uncorrected CHD were analyzed. RESULTS: Of 5,739 pregnancies in 53 countries, 3,295 women had CHD, 1,059 of which were uncorrected cases. Of these, 41.4% were from emerging countries. There were marked differences between the cardiac defects in uncorrected cases versus those in corrected CHD cases with primary shunt lesions (44.7% vs. 32.4%, respectively), valvular abnormalities (33.5% vs. 12.6%, respectively), and Tetralogy of Fallot and pulmonary atresia (0.8% vs. 20.3%, respectively; p < 0.001). In patients with uncorrected CHD, 6.8% were in modified World Health Organization risk class IV, approximately 10% had pulmonary hypertension (PH), and 3% were cyanotic prior to pregnancy. Maternal mortality and heart failure (HF) in the women with uncorrected CHD were 0.7% and 8.7%, respectively. Eisenmenger syndrome was associated with a very high risk of cardiac events (65.5%), maternal mortality (10.3%), and HF (48.3%). Coming from an emerging country was associated with higher pre-pregnancy signs of HF, PH, and cyanosis (p < 0.001) and worse maternal and fetal outcomes, with a 3-fold higher rate of hospital admissions for cardiac events and intrauterine growth retardation (p < 0.001). CONCLUSIONS: Marked differences between cardiac conditions in pregnant women with uncorrected CHD and those in corrected CHD were found, with a markedly worse outcome, particularly in women with Eisenmenger syndrome and from emerging countries.
Authors: Yang Liu; Yanna Li; Jun Zhang; Wenjuan Zhao; Zhaoliang Bao; Xiaolong Ma; Yichen Zhao; Cheng Zhao; Kemin Liu; Qing Ye; Lixiao Su; Yao Yang; Jing Yang; Gang Li; Xiangming Fan; Jiangang Wang Journal: Front Cardiovasc Med Date: 2022-01-21
Authors: Cyntia Puspa Pitaloka; Absa Secka; Ernawati Ernawati; Agus Sulistyono; Hermanto Tri Juwono; Erry Gumilar Dachlan; Aditiawarman Aditiawarman Journal: J Public Health Res Date: 2021-07-14