Pregnancy in women with pre-existent ischaemic heart disease: a systematic review with individualised patient data. Issue 11 (21st February 2019)

• Record Type: Journal Article
• Authors: Lameijer, Heleen; Burchill, Luke J; Baris, Lucia; Ruys, Titia PE; Roos-Hesselink, Jolien W; Mulder, Barbara J M; Silversides, Candice K; van Veldhuisen, Dirk J; Pieper, Petronella G
• Is Part Of: Heart. Volume 105:Issue 11(2019)
• Page Start: 873
• Page End: 880
• Publication Date: 2019-02-21
• Subjects: ischaemic heart disease -- coronary artery disease -- pregnancy; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2018-314364
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Introduction: Studies on pregnancy risk in women with ischaemic heart disease (IHD) have mainly excluded pregnancies in women with pre-existent IHD. There is a need for better information about the pregnancy risks in these women and their offspring. Methods: We performed a systematic review searching the PubMed/MEDLINE public database for pregnancy in women with pre-existent IHD analysing the cardiac, obstetric and fetal/neonatal outcome of pregnancy in women with pre-existing IHD. Individual patient data were requested from large series. The primary outcome endpoints was a composite of ischaemic complications including maternal death, acute coronary syndrome and ventricular tachycardia. Results: 116 women with pre-existent IHD had 124 pregnancies including one twin pregnancy. They had a 21% chance of having an uncomplicated pregnancy (completed pregnancy without cardiovascular, obstetric or fetal/neonatal complications, n=26). Primary (ischaemic) endpoints occurred in 9% (n=11). Women with atherosclerosis had more cardiovascular complications compared with pregnancies in women with other underlying pathology for IHD (50%vs23%, P=0.02) but no significant difference in occurrence of primary endpoints (13% vs 9%, P=0.53). There were two maternal cardiac deaths (2%), one of which occurred in the 18th week of pregnancy and the other postpartum. Obstetric complications occurred in 58% (n=65) of pregnancies and fetal/neonatal complications in 42% (n=47). Conclusion: Pregnancies in women with pre-existing IHD are high-risk pregnancies. These women have a high risk of ischaemic cardiovascular complications including 2% maternal mortality. The risk of ischaemic complications is especially high among women with atherosclerotic coronary artery disease.