Impact of Type of Maternal Cardiovascular Disease on Pregnancy Outcomes Among Women Managed in a Multidisciplinary Cardio-Obstetrics Program.

BACKGROUND: Maternal cardiovascular disease (CVD) complicates up to 4% of pregnancies in the United States. Knowledge regarding the impact of CVD category is limited. OBJECTIVE: The purpose of this study is to compare maternal and neonatal outcomes between women with different types of cardiovascular disease managed in a multidisciplinary program. STUDY DESIGN: Retrospective cohort study of patients receiving care in a multidisciplinary program with Maternal Fetal Medicine and Cardiology at a single institution between March 2010 and November 2019 with documented structural or functional cardiovascular disease. Women were categorized as having congenital heart disease, acquired heart disease, arrhythmias/channelopathies or aortopathies. Women were excluded from pregnancy outcome analysis if they never became pregnant or delivered at a different institution. Outcomes were analyzed by disease category using univariate techniques. RESULTS: 232 women with 253 pregnancies met inclusion criteria for pregnancy outcome analysis: 77 (30.4%) with congenital heart disease, 63 (24.9%) with acquired heart disease, 94 (37.2%) with arrhythmias/ channelopathies and 19 (7.5%) with aortopathies. Obesity and hypertension were more common in women with acquired heart disease, and women with acquired heart disease and arrhythmias had higher CARPREG II scores. Most women had good maternal and neonatal outcomes. Preeclampsia occurred more commonly in women with acquired heart disease (27.0% with acquired heart disease vs. 10.4% with congenital heart disease, 13.8% with arrhythmias/ channelopathies, 0% with aortopathies, p=0.009). Indicated preterm birth was highest for women with acquired heart disease (15.9%). Significant postpartum arrhythmias occurred in 2.4% of women. Preconception counseling was underutilized. CONCLUSIONS: Most women with preexisting cardiovascular disease experience good pregnancy and neonatal outcomes when managed in a specialized, multidisciplinary program. Women with acquired heart disease are at highest risk for pregnancy complications such as preeclampsia and preterm birth