Key result
The mWHO classification demonstrated satisfactory discrimination (AUC 0.73) for predicting MACE, which occurred in 6.6% of pregnancies, while CARPREG-II showed modest predictive ability (AUC 0.66).
Why the study?
Most data on cardiac disease in pregnancy come from high-income Western countries, limiting applicability to low- and middle-income countries.
How accurately do the mWHO classification and CARPREG-II scores predict major adverse cardiac events in pregnant women with heart disease in an LMIC setting?
Cohort (n=521)
No
How accurately do the mWHO classification and CARPREG-II scores predict major adverse cardiac events in pregnant women with heart disease in an LMIC setting?
Effect estimate: AUC 0.73 (mWHO), AUC 0.66 (CARPREG-II)
Retrospective cohort study evaluates maternal and perinatal outcomes in pregnancies with heart disease, suggesting a need for better risk models.
Background Cardiac disease in pregnancy presents complex clinical challenges and remains a leading cause of non-obstetric maternal mortality worldwide. Most available data on the prevalence and outcomes of heart disease in pregnancy come from high-income Western countries, limiting their applicability to low- and middle-income countries (LMICs). This study, conducted at a tertiary perinatal center in an LMIC setting, aims to describe the spectrum of cardiovascular disease in pregnancy and to evaluate maternal and perinatal outcomes, contributing context-specific evidence to the evolving field of cardio-obstetrics. Methods We conducted a retrospective cohort study of pregnant women with pre-existing cardiac disease or heart disease first diagnosed during pregnancy, managed at our institute over an eleven-year period (January 2013 to December 2023). Major adverse cardiac events (MACE), along with obstetric and neonatal outcomes, were recorded. Receiver operating characteristic (ROC) analysis was performed to assess the predictive accuracy of Modified World Health Organization (mWHO) classification and CARPREG-II scores for MACE. Results The cohort included 606 pregnancies in 521 women. Congenital heart disease was the most common diagnosis (41.1%), followed by valvular heart disease (32.8%) and arrhythmias (21.3%). Nearly one-quarter of women were diagnosed with cardiac disease during pregnancy. MACE occurred in 6.6% of pregnancies. mWHO classification demonstrated satisfactory discrimination for predicting MACE(AUC 0.73), while CARPREG-II showed modest predictive ability(AUC 0.66). Conclusion Risk prediction tools developed in Western populations may not perform uniformly across diverse settings. Changing patterns of cardiac disease in pregnancy highlight the need for risk models that better reflect contemporary and region-specific cardiovascular profiles.
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Sukayogula et al. (2026) conducted a cohort in Cardiac disease in pregnancy (n=521). mWHO classification and CARPREG-II scores was evaluated on Major adverse cardiac events (MACE) (AUC 0.73 (mWHO), AUC 0.66 (CARPREG-II)). The mWHO classification demonstrated satisfactory discrimination (AUC 0.73) for predicting MACE, which occurred in 6.6% of pregnancies, while CARPREG-II showed modest predictive ability (AUC 0.66).
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