Prospective multicenter study of pregnancy outcomes in women with heart disease

Background-The maternal and neonatal risks associated with pregnancy in wom en with heart disease receiving comprehensive prenatal care have not been w ell defined. Methods and Results-We prospectively enrolled 562 consecutive pregnant wome n with heart disease and determined the outcomes of 599 pregnancies not end ing in miscarriage. Pulmonary edema, arrhythmia, stroke, or cardiac death c omplicated 13% of pregnancies. Prior cardiac events or arrhythmia, poor fun ctional class or cyanosis, left heart obstruction, and left ventricular sys tolic dysfunction independently predicted maternal cardiac complications; t he cardiac event rate can be predicted using a risk index incorporating the se predictors. Neonatal complications (20% of pregnancies) were associated with poor functional class or cyanosis, left heart obstruction, anticoagula tion, smoking, and multiple gestations. Conclusions-Pregnancy in women with heart disease is associated with signif icant cardiac and neonatal complications, despite state-of-the-art obstetri c and cardiac care. Maternal cardiac risk can be predicted with the use of a risk index.