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

Adult congenital heart diseases Cardiomyopathy Heart valve diseases Maternal mortality Pregnant women

Journal

Archives of cardiovascular diseases
ISSN: 1875-2128
Titre abrégé: Arch Cardiovasc Dis
Pays: Netherlands
ID NLM: 101465655

Informations de publication

Date de publication:
12 Apr 2024
Historique:
received: 12 12 2023
revised: 24 02 2024
accepted: 26 02 2024
medline: 22 4 2024
pubmed: 22 4 2024
entrez: 21 4 2024
Statut: aheadofprint

Résumé

Cardiovascular diseases (CVDs) are currently the leading cause of maternal death in Western countries. Although multidisciplinary cardio-obstetric teams are recommended to improve the management of pregnant women with CVD, data supporting this approach are scarce. To describe the characteristics and outcomes of pregnant patients with CVD managed within the cardio-obstetric programme of a tertiary centre. We included every pregnant patient with history of CVD managed by our cardio-obstetric team between June 2017 and December 2019, and collected all major cardiovascular events (death, heart failure, acute coronary syndromes, stroke, endocarditis and aortic dissection) that occurred during pregnancy, peripartum and the following year. We included 209 consecutive pregnancies in 202 patients. CVDs were predominantly valvular heart diseases (37.8%), rhythm disorders (26.8%), and adult congenital heart diseases (22.5%). Altogether, 47.4% were classified modified World Health Organization (mWHO)>II, 66.5% had CARdiac disease in PREGnancy score (CARPREG II)≥2 and 80 pregnancies (38.3%) were delivered by caesarean section. Major cardiovascular events occurred in 16 pregnancies (7.7%, 95% confidence interval [CI] 4.5-12.2) during pregnancy and in three others (1.5%, 95% CI 0.3-4.1) during 1-year follow-up. Most events (63.1%) occurred in the 16.3% of patients with unknown CVD before pregnancy. The management of pregnant patients with CVD within a cardio-obstetric team seems encouraging as we found a relatively low rate of cardiovascular events compared to the high-risk profile of our population. However, most of the remaining events occurred in patients without cardiac monitoring before pregnancy.

Sections du résumé

BACKGROUND BACKGROUND
Cardiovascular diseases (CVDs) are currently the leading cause of maternal death in Western countries. Although multidisciplinary cardio-obstetric teams are recommended to improve the management of pregnant women with CVD, data supporting this approach are scarce.
AIMS OBJECTIVE
To describe the characteristics and outcomes of pregnant patients with CVD managed within the cardio-obstetric programme of a tertiary centre.
METHODS METHODS
We included every pregnant patient with history of CVD managed by our cardio-obstetric team between June 2017 and December 2019, and collected all major cardiovascular events (death, heart failure, acute coronary syndromes, stroke, endocarditis and aortic dissection) that occurred during pregnancy, peripartum and the following year.
RESULTS RESULTS
We included 209 consecutive pregnancies in 202 patients. CVDs were predominantly valvular heart diseases (37.8%), rhythm disorders (26.8%), and adult congenital heart diseases (22.5%). Altogether, 47.4% were classified modified World Health Organization (mWHO)>II, 66.5% had CARdiac disease in PREGnancy score (CARPREG II)≥2 and 80 pregnancies (38.3%) were delivered by caesarean section. Major cardiovascular events occurred in 16 pregnancies (7.7%, 95% confidence interval [CI] 4.5-12.2) during pregnancy and in three others (1.5%, 95% CI 0.3-4.1) during 1-year follow-up. Most events (63.1%) occurred in the 16.3% of patients with unknown CVD before pregnancy.
CONCLUSIONS CONCLUSIONS
The management of pregnant patients with CVD within a cardio-obstetric team seems encouraging as we found a relatively low rate of cardiovascular events compared to the high-risk profile of our population. However, most of the remaining events occurred in patients without cardiac monitoring before pregnancy.

Identifiants

DOI: 10.1016/j.acvd.2024.02.009 PMID: 38644069
pubmed: 38644069
pii: S1875-2136(24)00056-1
doi: 10.1016/j.acvd.2024.02.009
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Elsevier Masson SAS. All rights reserved.

Auteurs

Marjorie Richardson (M)

Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France. Electronic address: Marjorie.richardson@chu-lille.fr.

Jean Philippe Bonnet (JP)

Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France.

Capucine Coulon (C)

Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France.

Olivia Domanski (O)

Department of Paediatrics and Congenital Heart Diseases, Heart and Lung Institute, Lille University Hospital, Lille, France.

Benjamin Constans (B)

Department of Anaesthesia, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France.

Max Gonzalez Estevez (MG)

Department of Anaesthesia, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France.

Sophie Gautier (S)

Department of Pharmacology, Lille University Hospital, Lille, France.

Luisa Marsili (L)

Department of Clinical Genetic, Lille University Hospital, Lille, France.

Yasmine Ould Hamoud (YO)

Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France.

Augustin Coisne (A)

Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Cardiovascular Research Foundation, New York, NY, USA; Inserm, U1011-EGID, Institut Pasteur de Lille, University of Lille, CHU de Lille, 59000 Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France.

Hélène Ridon (H)

Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France.

Anne-Sophie Polge (AS)

Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France.

Stéphanie Mouton (S)

Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France.

Yasmine Haddad (Y)

Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France.

Francis Juthier (F)

Faculté de médecine de Lille, université de Lille, Lille, France; Department of Surgery, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Inserm U1011, Institut Pasteur de Lille, Lille, France.

Mouhamed Moussa (M)

Department of Anaesthesia, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France.

Claire Mounier Vehier (CM)

Department of Vascular Medicine and Hypertension, Heart and Lung Institute, Lille University Hospital, Lille, France.

Gilles Lemesle (G)

Faculté de médecine de Lille, université de Lille, Lille, France; Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France; FACT (French Alliance for Cardiovascular Trial), Paris, France.

Guillaume Schurtz (G)

Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France.

Charles Garabedian (C)

Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; METRICS, ULR 2694, Assessment of Health Technologies and Medical Practices, Lille, France.

Mercedes Jourdain (M)

Faculté de médecine de Lille, université de Lille, Lille, France; Intensive Care Unit, CHU de Lille, Lille, France; Inserm U1190, Lille, France.

Sandro Ninni (S)

Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France; Department of Cardiology, Heart and Lung Institute, Lille University Hospital, Lille, France.

François Brigadeau (F)

Department of Cardiology, Heart and Lung Institute, Lille University Hospital, Lille, France.

David Montaigne (D)

Department of Clinical Physiology and Echocardiography, Heart Valve Clinic, Heart and Lung Institute, Lille University Hospital, Lille, France; Inserm, U1011-EGID, Institut Pasteur de Lille, University of Lille, CHU de Lille, 59000 Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; European Genomic Institute for Diabetes (E.G.I.D.), FR 3508, Lille, France.

Nicolas Lamblin (N)

Faculté de médecine de Lille, université de Lille, Lille, France; Cardiac Intensive Care Unit, Heart and Lung Institute, CHU de Lille, Lille, France; Inserm U1167, Institut Pasteur de Lille, Lille, France.

Louise Ghesquiere (L)

Department of Obstetrics, Jeanne-de-Flandre Maternity, Lille University Hospital, Lille, France; Faculté de médecine de Lille, université de Lille, Lille, France; METRICS, ULR 2694, Assessment of Health Technologies and Medical Practices, Lille, France.

Classifications MeSH