Pregnancy Outcomes in Patients With Heart Disease in China

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To analyze pregnancy outcomes of patients with heart disease in a single center and to explore the risk factors of adverse outcomes. One thousand thirty-three pregnant women with heart disease were retrospectively included from 2010 to 2017. We collected data of maternal, obstetric, and fetal outcomes. Among 1,086 pregnancies, 295 (27.1%) with congenital heart disease, 244 (22.5%) with rheumatic heart disease, 387 (35.6%) with arrhythmia, and 55 (5.1%) with cardiomyopathy. There were 8 (0.7%) maternal deaths. Risk factors of mortality were New York Heart Association (NYHA) classification IV (p <0.001), cardiac surgery during pregnancy (p <0.001), and general anesthesia (p <0.001). Maternal cardiac complications occurred in 6.7% of women, with most in the cardiomyopathy (26.0%) and rheumatic heart disease (32.9%) groups. Multivariate logistic regression modeling was used to analyze the potential risk factors. NYHA classification III and IV independently predicted worse maternal outcomes. Peripartum intensive care unit admission rate was 10.2%. Admission to intensive care unit was associated with NYHA classification II/III/IV, modified World Health Organization (mWHO) classification II-III/III/IV, and cardiac surgery during pregnancy. In conclusion, pregnancy with heart disease is at higher risk of complications for both women and neonates. In our findings, maternal morbidity is associated with NYHA classification and mWHO classification.

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Methods

This study was conducted by the Declaration of Helsinki and was also approved by the Medical Ethics Committee of Guangdong Provincial People's Hospital. Patient consent to review their medical records was not required, as this was an observational retrospective study that did not infringe upon the interests or rights of the patients. All data were strictly confidential. After acquiring institutional review board approval and permission to waive consent, we performed a retrospective study of

Results

Our institution is a high-risk heart disease referral center. Most pregnant women with severe heart disease in south China were sent to our hospital. It had about 2,270 deliveries annually, and the incidence of maternal heart disease was ranged from 2.4% to 8.9%.

The composing data of the study population was shown in Figure 2. Arrhythmia was the primary diagnosis that must have had symptomatic sustained tachyarrhythmias or bradyarrhythmias requiring treatment during pregnancy. Other valvular

Discussion

Recent studies,6,7 have reported the largest cohort of outcomes of pregnancy with heart diseases. In this retrospective study of a South China tertiary cardiac center during the 8 years, we observed 1,086 pregnancies with different kinds of heart disease.

The composition of pregnancy with structural heart disease showed in our study is similar to those in developed countries.6,8 In our investigation, the number of pregnancies with heart disease increased sharply in 2014. Since then, the number

Disclosures

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Author Contributions

Jiaqi Hu: Conceptualization, Methodology, Writing - Original Draft; Yingxian Ye: Data curation, Writing- Original draft preparation; Anyi Lu: Validation, Investigation, Resources; Liwen Chen: Formal analysis, Supervision; Yongjian Mai: Validation, Writing - Original Draft; Guiting Huang: Validation, Writing - Original Draft; Sheng Wang: Supervision, Writing- Reviewing and Editing.

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