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

    Research output: Contribution to journalReview article

    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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    Myocardial Ischemia
    Pregnancy
    Obstetrics
    Maternal Death
    High-Risk Pregnancy
    Twin Pregnancy
    Maternal Mortality
    Pregnancy Outcome
    Acute Coronary Syndrome
    Ventricular Tachycardia
    PubMed
    MEDLINE
    Postpartum Period
    Coronary Artery Disease
    Atherosclerosis
    Databases
    Pathology

    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., ... 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

    Pregnancy in women with pre-existent ischaemic heart disease : A systematic review with individualised patient data. / Lameijer, Heleen; Burchill, Luke; Baris, Lucia; Ruys, Titia P.E.; Roos-Hesselink, Jolien W.; Mulder, Barbara J.M.; Silversides, Candice K.; Van Veldhuisen, Dirk J.; Pieper, Petronella G.

    In: Heart, 01.01.2019.

    Research output: Contribution to journalReview article

    Lameijer, H, Burchill, L, Baris, L, Ruys, TPE, Roos-Hesselink, JW, Mulder, BJM, Silversides, CK, Van Veldhuisen, DJ & Pieper, PG 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
    Lameijer, Heleen ; Burchill, Luke ; Baris, Lucia ; Ruys, Titia P.E. ; Roos-Hesselink, Jolien W. ; Mulder, Barbara J.M. ; Silversides, Candice K. ; Van Veldhuisen, Dirk J. ; Pieper, Petronella G. / Pregnancy in women with pre-existent ischaemic heart disease : A systematic review with individualised patient data. In: Heart. 2019.
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    title = "Pregnancy in women with pre-existent ischaemic heart disease: A systematic review with individualised patient data",
    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.",
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    author = "Heleen Lameijer and Luke Burchill and Lucia Baris and Ruys, {Titia P.E.} and Roos-Hesselink, {Jolien W.} and Mulder, {Barbara J.M.} and Silversides, {Candice K.} and {Van Veldhuisen}, {Dirk J.} and Pieper, {Petronella G.}",
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    T2 - A systematic review with individualised patient data

    AU - Lameijer, Heleen

    AU - Burchill, Luke

    AU - Baris, Lucia

    AU - Ruys, Titia P.E.

    AU - Roos-Hesselink, Jolien W.

    AU - Mulder, Barbara J.M.

    AU - Silversides, Candice K.

    AU - Van Veldhuisen, Dirk J.

    AU - Pieper, Petronella G.

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    N2 - 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.

    AB - 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.

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    KW - ischaemic heart disease

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