The effect of valvular heart disease on maternal and fetal outcome of pregnancy

OBJECTIVES The aim of this study was to evaluate the association between va lvular heart disease (VHD) and maternal and fetal outcome in a relatively l arge group of patients by a comparison to a well-matched control group. BACKGROUND Available information regarding outcome of pregnancy in Women wi th VHD is limited to either anecdotal reports or small series of patients w ithout an appropriate control. METHODS A better understanding of the effects of valvular abnormalities on pregnancy outcome is of value for risk assessment and the design of a thera peutic plan. A retrospective evaluation was made of 66 pregnancies in 64 wo men with VHD cared for at a tertian-care center with a high-risk obstetrics /cardiology clinic and 66 individually selected normal pregnant women match ed in age, ethnicity, obstetrical and medical history, time of initial pren atal care, and year of pregnancy. RESULTS Women with VHD had a significantly higher incidence of congestive h eart failure (38% vs. 0%; p < 0.00001), arrhythmias (15% vs. 0%, p = 0.002) , initiation or increase of cardiac medications (41% vs. 2%, p < 0.0001), a nd hospitalizations (35% vs. 2%, p < 0.0001). Mortality however, occurred i n only one patient (2% vs. 0%, p = NS) with aortic stenosis (AS) and coarct ation. Moreover, VHD also had an effect on fetal outcome, resulting in an i ncreased preterm delivery (23% vs. 6%, p = 0.03), intrauterine growth retar dation (21% vs. 0%, p < 0.0001), and a reduced birth weight (2897 +/- 838 g vs. 3366 +/- 515 g, p = 0.0003). Increased maternal morbidity and unfavora ble fetal outcome were seen mostly in patients with moderate and severe mit ral stenosis (MS) and AS. CONCLUSIONS Pregnancy in women with MS and AS is associated with marked inc rease in maternal morbidity and unfavorable effect on fetal outcome, which are related to severity of disease. Despite high maternal morbidity, mortal ity is rare. (J Am Coil Cardiol 2001;37:893-9) (C) 2001 by the American Col lege of Cardiology.