Pregnancy outcomes in women with heart disease

Background As the Shanghai Obstetrical Cardiology Intensive Care Center,our hospital has accumulated a largenumber of clinical data of pregnant women with heart disease.This paper is a retrospective analysis of 1142 pregnanciesin women with heart disease so as to evaluate the maternal and fetal outcomes of these patients.Methods A retrospective analysis was carried out for pregnancies in 1142 women with heart disease who delivered inShanghai Obstetrical Cardiology Intensive Care Center between 1993 and 2007.Results In this study,main heart diseases in pregnancy were arrhythmia (n=359,31.4%),congenital heart disease(CHD;n=291,25.5%),and myocarditis and its sequelae (n=284,24.9%);based on the functional classification criteria ofNew York Heart Association (NYHA),more than half (n=678,59.4%) of patients were classified NYHA Class Ⅰ;pregnantwomen in NHYA Class Ⅰ-Ⅱ (n=951,83.3%) commonly had arrhythmia,myocarditis and its sequelae,while those in NHYAClass Ⅲl-Ⅳ (n=191,16.7%) mainly had CHD,rheumatic heart disease (RHD),cardiopathy induced by hypertensivedisorders complicating pregnancy,and peripartum cardiomyopathy (PPCM).Cardiac failure occurred in 97 (8.5%)patients,and 8 (0.7%) maternal deaths and 12 (1.1%) perinatal deaths were reported in this study.Compared with thosein NHYA Class Ⅰ-Ⅱ,women in NHYA Class Ⅲ-Ⅳ had a significantly lower gestational age at birth (P<0.05),lower birthweight (P<0.01),and higher incidence of preterm delivery,small for gestational age and perinatal death (P<0.01).Theincidence of cardiac failure in pregnant women with cardiopathy induced by hypertensive disorders complicatingpregnancy and PPCM was relatively high,with a rate of 80% and 52.2%,respectively.After cardiac operation,131(90.3%) women were in classified NHYA Class Ⅰ-Ⅱ and 14 (9.7%) in NHYA Class Ⅲ-Ⅳ.Conclusions Arrhythmia is the type of heart disease that has a highest incidence in patients with heart disease inpregnancy,while main types of heart disease that impair cardiac function are CHD and RHD;cardiac failure is morefrequently caused by cardiopathy induced by hypertensive disorders complicating pregnancy and PPCM;impairedcardiac function increases perinatal morbidity;cardiac surgery before pregnancy could improve the cardiacfunction.