Clinical Investigation

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Pregnancy in patients with heart disease: Experience with 1,000 cases

  1. Walkiria Samuel Avila M.D.*,
  2. Eduardo Giusti Rossi M.D.,
  3. José Antonio Franchini Ramires M.D., FACC,
  4. Max Grinberg M.D.,
  5. Maria Rita Lemos Bortolotto M.D.,
  6. Marcelo Zugaib M.D.,
  7. Protasio Lemos Da Luz M.D., FACC

Article first published online: 5 DEC 2006

DOI: 10.1002/clc.4960260308

Issue

Clinical Cardiology

Clinical Cardiology

Volume 26, Issue 3, pages 135–142, March 2003

Additional Information

How to Cite

Avila, W. S., Rossi, E. G., Ramires, J. A. F., Grinberg, M., Bortolotto, M. R. L., Zugaib, M. and Luz, P. L. D. (2003), Pregnancy in patients with heart disease: Experience with 1,000 cases. Clinical Cardiology, 26: 135–142. doi: 10.1002/clc.4960260308

Author Information

  1. Heart Institute (InCor) University of São Paulo Medical School Brazil and Department of Obstetrics of the Clinics Hospital, University of São Paulo Medical School São Paulo, Brazil

*Rua Dr Enéas de Carvalho Aguiar n° 44 Cerqueira César São Paulo- SP, Brazil. CEP 05403-900

Publication History

  1. Issue published online: 5 DEC 2006
  2. Article first published online: 5 DEC 2006
  3. Manuscript Accepted: 26 MAR 2002
  4. Manuscript Received: 6 FEB 2001

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Keywords:

  • pregnancy;
  • heart disease;
  • maternal outcome;
  • fetal outcome;
  • cardiac complication

Abstract

Background: Previously, the high maternal mortality in cardiac patients who became pregnant prompted the assertion: Women with an abnormal heart should not become pregnant. This long-standing notion needs to be revised today.

Hypothesis: The study was undertaken to ascertain the experience with a large series of pregnant women with cardiac disease cared for in the same referral center.

Methods: From 1989 to 1999, 1,000 pregnant women with heart disease were followed by the same clinical and obstetric team. The cardiac diseases included rheumatic heart disease (55.7%), congenital heart disease (19.1%), Chagas' disease (8.5%), cardiac arrhythmias (5.1%), cardiomyopathies (4.3%), and others (7.3%).

Results: Of the pregnant women studied, 765 (76.5%) experienced no cardiovascular events during the study; 235 (23.5%) patients had the following cardiovascular complications: congestive heart failure (12.3%), cardiac arrhythmias (6%), thromboembolism (1.9%), angina (1.4%), hypoxemia (0.7%), infective endocarditis (0.5%), and other complications (0.7%). Clinical treatment allowed adequate management in 161 (68.8%) patients; however, 46 (19.6%) patients underwent interventional procedures because of refractory complications. The general maternal mortality rate was 2.7%. Of the 915 (91.5%) infants who were discharged, 119 (13%) were premature.

Conclusion: Pregnancy in women with heart disease is still associated with considerable morbidity and mortality rates, which strongly correlate to maternal underlying disease. Strict prenatal care and early risk stratification during gestation are fundamental measures to improve the prognosis of pregnancy in women with heart disease.

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