Hypertensive disorders of pregnancy in women with heart disease were associated with significantly higher maternal mortality (1.4% vs 0.6%, P=0.04) and heart failure (18.5% vs 10.6%, P<0.001).
Observational (n=5,739)
Yes
Does the presence of hypertensive disorders of pregnancy increase adverse maternal and perinatal outcomes in pregnant women with heart disease?
Hypertensive disorders of pregnancy, particularly pre-eclampsia, are associated with significantly higher rates of maternal mortality and heart failure in pregnant women with underlying heart disease.
Absolute Event Rate: 1.4% vs 0.6%
p-value: p=0.04
AIMS: Hypertensive disorders of pregnancy (HDP) occur in 10% of pregnancies in the general population, pre-eclampsia specifically in 3-5%. Hypertensive disorders of pregnancy may have a high prevalence in, and be poorly tolerated by, women with heart disease. METHODS AND RESULTS: The prevalence and outcomes of HDP (chronic hypertension, gestational hypertension or pre-eclampsia) were assessed in the ESC EORP ROPAC (n = 5739), a worldwide prospective registry of pregnancies in women with heart disease.The overall prevalence of HDP was 10.3%, made up of chronic hypertension (5.9%), gestational hypertension (1.3%), and pre-eclampsia (3%), with significant differences between the types of underlying heart disease (P < 0.05). Pre-eclampsia rates were highest in women with pulmonary arterial hypertension (PAH) (11.1%), cardiomyopathy (CMP) (7.1%), and ischaemic heart disease (IHD) (6.3%). Maternal mortality was 1.4 and 0.6% in women with vs. without HDP (P = 0.04), and even 3.5% in those with pre-eclampsia. All pre-eclampsia-related deaths were post-partum and 50% were due to heart failure. Heart failure occurred in 18.5 vs. 10.6% of women with vs. without HDP (P < 0.001) and in 29.1% of those with pre-eclampsia. Perinatal mortality was 3.1 vs. 1.7% in women with vs. without HDP (P = 0.019) and 4.7% in those with pre-eclampsia. CONCLUSION: Hypertensive disorders of pregnancy and pre-eclampsia rates were higher in women with CMP, IHD, and PAH than in the general population. Adverse outcomes were increased in women with HDP, and maternal mortality was strikingly high in women with pre-eclampsia. The combination of HDP and heart disease should prompt close surveillance in a multidisciplinary context and the diagnosis of pre-eclampsia requires hospital admission and continued monitoring during the post-partum period.
“Pregnancy is safe for most women with heart disease but for some it is too risky. Our study shows that fewer women with heart disease die or have heart failure during pregnancy than ten years ago. However, nearly one in ten women with pulmonary arterial hypertension died during pregnancy or early post-partum.”
Ramlakhan et al. (Tue,) conducted a observational in Heart disease in pregnancy (n=5,739). Hypertensive disorders of pregnancy (HDP) vs. Without HDP was evaluated on Maternal mortality (p=0.04). Hypertensive disorders of pregnancy in women with heart disease were associated with significantly higher maternal mortality (1.4% vs 0.6%, P=0.04) and heart failure (18.5% vs 10.6%, P<0.001).