Cardiovascular Care for Pregnant Women With Cardiovascular Disease
Key result
Cardio-obstetrics care for pregnant women with CVD links to a 98% live birth rate.
- n=306
Why the study?
Cardio-obstetrics provides team-based maternal care, but clinical characteristics, maternal and fetal outcomes, and cardiovascular readmissions in pregnant women with underlying CVD followed by such teams required description.
What are the maternal and fetal outcomes and readmission rates in pregnant women with cardiovascular disease managed by a cardio-obstetrics team?
Key Points
- To evaluate the clinical characteristics, maternal and fetal outcomes, and postpartum cardiovascular readmission rates among pregnant women with underlying cardiovascular disease managed by a multidisciplinary cardio-obstetrics team.
- Retrospective cohort analysis of N=306 pregnant women with cardiovascular disease evaluated by a cardio-obstetrics team at a quaternary care hospital in New York City between January 2010 and December 2019, with a median follow-up of 2.6 years.
- Evaluated clinical demographics, CARPREG II risk scores, maternal and fetal complications, intensive care admissions, and cardiovascular readmission rates at 30 days and 30–90 days postpartum.
- The cohort had a median age of 29 years, 74.2% Medicaid coverage, and a median CARPREG II score of 3 (42.5% with score ≥4); common conditions were arrhythmia (28.8%), congenital heart disease (23.5%), and cardiomyopathy (23.5%).
- Pregnancy complications included gestational diabetes (11.4%), gestational hypertension (9.5%), and preeclampsia (12.1%), with delivery ICU admissions occurring in 8.8% of patients and one maternal death in a patient with Eisenmenger syndrome.
- Live births occurred in 98% of pregnancies at a median gestational age of 38 weeks (IQR: 37–39), with a 30-day postpartum cardiovascular readmission rate of 2% and a 30- to 90-day rate of 4.6%.
Study Design
Type
Cohort (n=306)
Multicenter
No
Structured PICO
What are the maternal and fetal outcomes and readmission rates in pregnant women with cardiovascular disease managed by a cardio-obstetrics team?
P
Population
306 pregnant women with underlying cardiovascular disease managed by a cardio-obstetrics team, followed for a median of 2.6 years.
E
Exposure
Management by a multidisciplinary cardio-obstetrics team
O
Outcome
Clinical characteristics, maternal and fetal outcomes, and cardiovascular readmissionshard clinical
A multidisciplinary cardio-obstetrics team approach for pregnant women with cardiovascular disease is associated with high rates of live births and low postpartum readmission rates.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“although this study wasn't designed to assess the benefit of cardio-obstetric teams relative to standard of care, its implementation of a multidisciplinary team-based care model showed excellent long-term outcomes.”
“Despite the high cardiovascular risk in our study population, we found low rates of maternal and fetal complications and a low rate of hospital readmissions after delivery compared to previously published national rates.”
“We suspect that some percentage of cardiac disease in pregnant women may go unnoticed or undetected, so it's hard to say exactly how common these problems are among pregnant women. Even in a normal pregnancy, women can experience shortness of breath or notice leg swelling. Therefore, even when cardiac disease may be present, these symptoms may be inadvertently minimized by women themselves or their providers.”
Implication
Supports multidisciplinary cardio-obstetrics care for pregnant women with CVD; leaves open whether this model improves outcomes in prospective studies.
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.
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Cite This Study
Magun et al. (2020) conducted a cohort in Cardiovascular disease in pregnancy (n=306). Cardio-obstetrics team management was evaluated on Maternal and fetal outcomes, and cardiovascular readmissions. Management of pregnant women with cardiovascular disease by a cardio-obstetrics team was associated with a 98% live birth rate and a 2% 30-day postpartum readmission rate.