Ischaemic heart disease linked to high-risk pregnancies
Pregnancies in women with pre-existing ischaemic heart disease (IHD) are at high risk of ischaemic cardiovascular complications, including maternal mortality, a study has found. The risk of adverse pregnancy outcomes is especially pronounced for atherosclerotic coronary artery disease.
Researchers conducted a systematic review of studies assessing the cardiac, obstetric and foetal/neonatal outcome and complications of pregnancy in women with pre-existing IHD. They analysed the primary endpoint of a composite of ischaemic complications including maternal death, acute coronary syndrome and ventricular tachycardia in individual patient-level data.
The analysis included 116 women with pre-existent IHD (mean age at diagnosis, 30.8 years) with 124 pregnancies, including one twin pregnancy. This group had a 21-percent chance of having an uncomplicated pregnancy (completed pregnancy without cardiovascular, obstetric or foetal/neonatal complications, n=26).
The primary (ischaemic) endpoints occurred in 11 women (9 percent). Cardiovascular complications were more common in pregnancies in women with atherosclerosis than in those with other underlying pathology for IHD (50 percent vs 23 percent; p=0.02). Conversely, there was no significant between-group difference in the occurrence of the primary endpoints (13 percent vs 9 percent; p=0.53).
There were two cases of maternal cardiac deaths (2 percent), one of which occurred in the 18th week of pregnancy and the other, postpartum. Obstetric complications occurred in 58 percent of pregnancies (n=65) and foetal/neonatal complications in 42 percent (n=47).
In light of the current data, researchers emphasized the importance of prepregnancy evaluation and counselling of women with pre-existing IHD. Pregnancies in this population should be managed as high-risk, and antenatal care should include frequent clinical assessment with focus on early detection of myocardial ischaemia. Finally, monitoring should continue during the postpartum period.