Adverse cardiovascular, obstetric and perinatal events during pregnancy and puerperium in patients with heart disease

Background and objectives: Cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. Materials and methods: Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalized with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric hemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. Results: 112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric hemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, P = .006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, P = .001) and heart failure (adjusted OR 16; 95% CI: 3-84, P = .001). An increased risk of obstetric hemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, P = .025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, P = .030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, P = .021). Conclusions: Severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital. (c) 2024 The Authors. Published by Elsevier Espa & nacute;a, S.L.U. This is an open access article under the CC BY -NC license (http://creativecommons.org/licenses/by-nc/4.0/).