TY - JOUR
T1 - Cardiovascular and Obstetric Delivery Complications in Pregnant Women With Valvular Heart Disease
AU - Minhas, Anum S.
AU - Rahman, Faisal
AU - Gavin, Nicole
AU - Cedars, Ari
AU - Vaught, Arthur Jason
AU - Zakaria, Sammy
AU - Resar, Jon
AU - Schena, Stefano
AU - Schulman, Steven
AU - Zhao, Di
AU - Hays, Allison G.
AU - Michos, Erin D.
N1 - Funding Information:
Dr. Minhas was supported by National Heart, Lung, and Blood Institute training grant T32HL007024 and the Johns Hopkins Lou and Nancy Grasmick Endowed Research Fellowship . Dr. Michos is supported by the Amato Fund for Women's Cardiovascular Health Research at Johns Hopkins University .
Funding Information:
Dr. Resar reports grants from Abbott Vascular Inc, grants from Medtronic Inc, grants from Medtronic Inc, other from Boston Scientific Corp, outside the submitted work. All other authors reports no disclosures or conflicts of interest.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/11/1
Y1 - 2021/11/1
N2 - Women with valvular heart disease may be more likely to have adverse obstetric and cardiovascular complications during pregnancy. Most current recommendations focus on stenotic lesions with less guidance regarding regurgitant lesions. We aimed to compare adverse events at delivery for women with various stenotic and regurgitant valvular diseases. We used the 2016 to 2018 National Inpatient Sample data to compare demographics, comorbidities, and obstetric and cardiovascular complications during delivery hospitalizations. After adjusting for clinical and socioeconomic factors, logistic regression was performed to investigate associations between valvular disease and outcomes. Among >11.2 million deliveries, 20,349 were in women with valvular disease. Women with valvular disease were older, had longer length of stays, and higher costs associated with delivery. They had higher prevalence of underlying cardiovascular comorbidities compared with women without valvular disease (hypertension: 5.1 vs 0.25%; pulmonary hypertension: 7.0 vs <0.1%). At delivery, they had higher adjusted odds of obstetric events including preeclampsia and/or eclampsia (aOR 1.9 [1.8 to 2.2]) and intrapartum/postpartum hemorrhage (aOR 1.4 [1.2 to 1.6]), and cardiovascular events including peripartum cardiomyopathy (aOR 65 [53 to 78]), pulmonary edema (aOR 17 [13 to 22]), acute ischemic heart disease (aOR 19 [12 to 30]) and arrhythmias (aOR 22 [19 to 27]). There were valve lesion-specific differences in the magnitude of risk but both stenotic and regurgitant lesions were associated with elevated risk of cardiovascular complications. In conclusion, pregnant women with stenotic and regurgitant valvular disease have a greater burden of cardiovascular comorbidities and increased odds of obstetric and cardiovascular events at delivery. These women may benefit from specialized care from a Cardio-Obstetrics team.
AB - Women with valvular heart disease may be more likely to have adverse obstetric and cardiovascular complications during pregnancy. Most current recommendations focus on stenotic lesions with less guidance regarding regurgitant lesions. We aimed to compare adverse events at delivery for women with various stenotic and regurgitant valvular diseases. We used the 2016 to 2018 National Inpatient Sample data to compare demographics, comorbidities, and obstetric and cardiovascular complications during delivery hospitalizations. After adjusting for clinical and socioeconomic factors, logistic regression was performed to investigate associations between valvular disease and outcomes. Among >11.2 million deliveries, 20,349 were in women with valvular disease. Women with valvular disease were older, had longer length of stays, and higher costs associated with delivery. They had higher prevalence of underlying cardiovascular comorbidities compared with women without valvular disease (hypertension: 5.1 vs 0.25%; pulmonary hypertension: 7.0 vs <0.1%). At delivery, they had higher adjusted odds of obstetric events including preeclampsia and/or eclampsia (aOR 1.9 [1.8 to 2.2]) and intrapartum/postpartum hemorrhage (aOR 1.4 [1.2 to 1.6]), and cardiovascular events including peripartum cardiomyopathy (aOR 65 [53 to 78]), pulmonary edema (aOR 17 [13 to 22]), acute ischemic heart disease (aOR 19 [12 to 30]) and arrhythmias (aOR 22 [19 to 27]). There were valve lesion-specific differences in the magnitude of risk but both stenotic and regurgitant lesions were associated with elevated risk of cardiovascular complications. In conclusion, pregnant women with stenotic and regurgitant valvular disease have a greater burden of cardiovascular comorbidities and increased odds of obstetric and cardiovascular events at delivery. These women may benefit from specialized care from a Cardio-Obstetrics team.
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U2 - 10.1016/j.amjcard.2021.07.038
DO - 10.1016/j.amjcard.2021.07.038
M3 - Article
C2 - 34452683
AN - SCOPUS:85113604503
SN - 0002-9149
VL - 158
SP - 90
EP - 97
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -