Original Investigation
Cardiovascular Care for Pregnant Women With Cardiovascular Disease

https://doi.org/10.1016/j.jacc.2020.08.071Get rights and content
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Abstract

Background

Cardio-obstetrics refers to a team-based approach to maternal care that includes multidisciplinary collaboration among maternal fetal medicine, cardiology, and others.

Objectives

This study sought to describe clinical characteristics, maternal and fetal outcomes, and cardiovascular readmissions in a cohort of pregnant women with underlying cardiovascular disease (CVD) followed by a cardio-obstetrics team.

Methods

We identified patients evaluated by our cardio-obstetrics team from January 1, 2010, through December 31, 2019, at a quaternary care hospital in New York City. Information was collected regarding demographics, comorbidities, underlying CVD, medications, maternal and fetal outcomes, and cardiovascular readmissions. Each patient was assigned a Cardiac Disease in Pregnancy (CARPREG) II score based on her clinical characteristics and underlying CVD.

Results

During the study period, 306 pregnant women (median age 29 years, 52.9% Hispanic or Latino) with CVD were seen. Most women (74.2%) were insured through Medicaid. The most common forms of CVD included arrhythmia (n = 88, 28.8%), congenital heart disease (n = 72, 23.5%), and cardiomyopathy (n = 72, 23.5%). The median CARPREG II score was 3; 130 patients (42.5%) had a CARPREG II score ≥4. Gestational diabetes occurred in 11.4%, gestational hypertension in 9.5%, and preeclampsia in 12.1% of women. Intensive care unit admission was required for 27 patients (8.8%) during delivery. Median gestational age for delivery was 38 weeks (interquartile range: 37 to 39). Live birth occurred in 98% of pregnancies. One maternal death occurred within a year of delivery in a woman with Eisenmenger syndrome. Following delivery, 30-day readmission rate was 2% and the rate of readmission from 30 to 90 days postpartum was 4.6%. Median follow-up was 2.6 years.

Conclusions

In a population of primarily Medicaid-insured pregnant women managed by a cardio-obstetrics team, maternal outcomes were encouraging and readmission rates following delivery were low. Prospective studies are needed to evaluate the impact of cardio-obstetric models of care on maternal outcomes.

Key Words

cardio-obstetrics
cardiovascular disease
pregnancy
women’s health

Abbreviations and Acronyms

ACEI
angiotensin-converting enzyme inhibitor
ACOG
American College of Obstetricians and Gynecologists
ARB
angiotensin receptor blocker
BMI
body mass index
CUIMC
Columbia University Irving Medical Center
CVD
cardiovascular disease
ICD
implantable cardioverter-defibrillator
IQR
interquartile range
LVAD
left ventricular assist device
NT-proBNP
N-terminal pro-B-type natriuretic peptide
PPM
permanent pacemaker

Cited by (0)

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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