1. Risk Associated With Valvular Regurgitation During Pregnancy
- Author
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Jasmine Grewal, Birgit Pfaller, Rachel M. Wald, Mathew Sermer, Nadia Gabarin, Marla Kiess, SM Samuel C. Siu, Jack M. Colman, SM Candice K. Silversides, and Angelo Dave Javier
- Subjects
Adult ,medicine.medical_specialty ,Heart disease ,complications ,Pregnancy Complications, Cardiovascular ,Heart Valve Diseases ,Regurgitation (circulation) ,heart disease ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Ontario ,valve lesions ,British Columbia ,business.industry ,Infant, Newborn ,Pregnancy Outcome ,Valvular regurgitation ,regurgitation ,medicine.disease ,Infant, Small for Gestational Age ,Cardiology ,Female ,pregnancy ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Pregnancies in women with regurgitant valve lesions are generally considered low risk, but this has not been well studied. Objectives: This study determined the frequency of adverse cardiac events (CEs) in pregnant women with moderate or severe regurgitant valve lesions. Methods: Maternal and fetal outcomes in women with moderate or severe chronic valve regurgitation enrolled in a prospective multicenter study on pregnancy outcomes were examined. Adverse CEs included heart failure, sustained arrhythmias, cardiac arrest, or death. A multivariate logistic regression model was used to identify determinants of CEs in women at the highest risk. Results: Outcomes of 430 pregnancies in women with moderate or severe regurgitant lesions were examined: 145 with mitral regurgitation (MR), 101 with pulmonary regurgitation (PR), 71 with multivalve disease, 73 with tricuspid regurgitation (TR), and 40 with aortic regurgitation (AR). Most women had associated congenital or acquired heart disease. Adverse CEs occurred in 13% of pregnancies: 27% of pregnancies with multivalve disease; 15% with MR; 15% with TR; 5% with AR; and 3% with PR. Maternal mortality was rare. In women with MR, TR, or multivalve disease (n = 289), left ventricular systolic dysfunction (p = 0.001), pulmonary hypertension (p = 0.005), and cardiac events before pregnancy (p < 0.001) were important determinants of CEs during pregnancy. Conclusions: Women with AR and PR are at low risk for cardiac complications during pregnancy. While many women with MR, TR, and multivalve regurgitation do well during pregnancy, additional clinical variables help stratify those at highest risk. This new information will enhance the quality and precision of preconception counseling and pregnancy planning.
- Published
- 2021