Management and outcomes of pregnant women with cardiovascular diseases in a cardio-obstetric team

• Published in: Archives of cardiovascular diseases Vol. 117; no. 5; pp. 343 - 350
• Main Authors: Richardson, Marjorie, Bonnet, Jean Philippe, Coulon, Capucine, Domanski, Olivia, Constans, Benjamin, Estevez, Max Gonzalez, Gautier, Sophie, Marsili, Luisa, Hamoud, Yasmine Ould, Coisne, Augustin, Ridon, Hélène, Polge, Anne-Sophie, Mouton, Stéphanie, Haddad, Yasmine, Juthier, Francis, Moussa, Mouhamed, Vehier, Claire Mounier, Lemesle, Gilles, Schurtz, Guillaume, Garabedian, Charles, Jourdain, Mercedes, Ninni, Sandro, Brigadeau, François, Montaigne, David, Lamblin, Nicolas, Ghesquiere, Louise
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Masson SAS 01.05.2024
• Subjects: Adult congenital heart diseases; Cardiomyopathy; Heart valve diseases; Maternal mortality; Pregnant women; Heart valve diseases; Maternal mortality; Pregnant women; Cardiomyopathy; Adult congenital heart diseases
• ISSN: 1875-2136; 1875-2128; 1875-2128
• DOI: 10.1016/j.acvd.2024.02.009

[Display omitted] •Cardiovascular diseases are the main cause of maternal death.•There is a call for improved care for pregnant patients with heart diseases.•We describe the results of a French cardio-obstetric network.•Management of these patients by a multidisciplinary Pregnancy Heart Team is promising. Cardiovascular diseases (CVDs) are currently the leading cause of maternal death in Western countries. Although multidisciplinary cardio-obstetric teams are recommended to improve the management of pregnant women with CVD, data supporting this approach are scarce. To describe the characteristics and outcomes of pregnant patients with CVD managed within the cardio-obstetric programme of a tertiary centre. We included every pregnant patient with history of CVD managed by our cardio-obstetric team between June 2017 and December 2019, and collected all major cardiovascular events (death, heart failure, acute coronary syndromes, stroke, endocarditis and aortic dissection) that occurred during pregnancy, peripartum and the following year. We included 209 consecutive pregnancies in 202 patients. CVDs were predominantly valvular heart diseases (37.8%), rhythm disorders (26.8%), and adult congenital heart diseases (22.5%). Altogether, 47.4% were classified modified World Health Organization (mWHO)>II, 66.5% had CARdiac disease in PREGnancy score (CARPREG II)≥2 and 80 pregnancies (38.3%) were delivered by caesarean section. Major cardiovascular events occurred in 16 pregnancies (7.7%, 95% confidence interval [CI] 4.5–12.2) during pregnancy and in three others (1.5%, 95% CI 0.3–4.1) during 1-year follow-up. Most events (63.1%) occurred in the 16.3% of patients with unknown CVD before pregnancy. The management of pregnant patients with CVD within a cardio-obstetric team seems encouraging as we found a relatively low rate of cardiovascular events compared to the high-risk profile of our population. However, most of the remaining events occurred in patients without cardiac monitoring before pregnancy.