Pregnancy in women with pre-existent ischaemic heart disease: A systematic review with individualised patient data

Heleen Lameijer, Luke Burchill, Lucia Baris, Titia P.E. Ruys, Jolien W. Roos-Hesselink, Barbara J.M. Mulder, Candice K. Silversides, Dirk J. Van Veldhuisen, Petronella G. Pieper

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    Abstract

    Introduction: Studies on pregnancy risk in women with ischaemic heart disease (IHD) have mainly excluded pregnancies in women with pre-existent IHD. There is a need for better information about the pregnancy risks in these women and their offspring. Methods: We performed a systematic review searching the PubMed/MEDLINE public database for pregnancy in women with pre-existent IHD analysing the cardiac, obstetric and fetal/neonatal outcome of pregnancy in women with pre-existing IHD. Individual patient data were requested from large series. The primary outcome endpoints was a composite of ischaemic complications including maternal death, acute coronary syndrome and ventricular tachycardia. Results: 116 women with pre-existent IHD had 124 pregnancies including one twin pregnancy. They had a 21% chance of having an uncomplicated pregnancy (completed pregnancy without cardiovascular, obstetric or fetal/neonatal complications, n=26). Primary (ischaemic) endpoints occurred in 9% (n=11). Women with atherosclerosis had more cardiovascular complications compared with pregnancies in women with other underlying pathology for IHD (50%vs23%, P=0.02) but no significant difference in occurrence of primary endpoints (13% vs 9%, P=0.53). There were two maternal cardiac deaths (2%), one of which occurred in the 18th week of pregnancy and the other postpartum. Obstetric complications occurred in 58% (n=65) of pregnancies and fetal/neonatal complications in 42% (n=47). Conclusion: Pregnancies in women with pre-existing IHD are high-risk pregnancies. These women have a high risk of ischaemic cardiovascular complications including 2% maternal mortality. The risk of ischaemic complications is especially high among women with atherosclerotic coronary artery disease.

    Original languageEnglish (US)
    JournalHeart
    DOIs
    StatePublished - Jan 1 2019

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    Keywords

    • coronary artery disease
    • ischaemic heart disease
    • pregnancy

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Lameijer, H., Burchill, L., Baris, L., Ruys, T. P. E., Roos-Hesselink, J. W., Mulder, B. J. M., Silversides, C. K., Van Veldhuisen, D. J., & Pieper, P. G. (2019). Pregnancy in women with pre-existent ischaemic heart disease: A systematic review with individualised patient data. Heart. https://doi.org/10.1136/heartjnl-2018-314364