The number of women with heart disease delivering babies increased by 24 percent over a 10-year period, a Stony Brook-led study shows. Reported in the American Journal of Cardiology, the research could prompt new guidelines for screening and care during pregnancy.
Kathleen Stergiopoulos, MD, PhD, Professor of Medicine in the Division of Cardiovascular Medicine and a specialist in heart disease in women at the Stony Brook Heart Institute, led the study of more than 80,000 women with heart disease.
From 2003 to 2012, researchers found, the prevalence of women with heart disease delivering babies increased by 24 percent. This jump may prompt greater awareness of heart disease in women of childbearing age, heighten individual screening of heart disease in pregnant patients, and institute a multidisciplinary approach to labor and delivery.
Heart disease is the most common cause of death among pregnant women in the United States and other developed countries. There remain significant gaps in understanding of the prevalence, trends and outcomes of heart disease in pregnancy in the U.S. population. Investigation of trends and outcomes in heart disease and pregnancy has been limited.
In this study, researchers used the Healthcare Cost and Utilization Project’s National Impatient Sample to better determine the trends and relationship between women with heart disease and delivering babies. To do this, they studied existing heart conditions and outcomes using a large sample of women with heart disease (81,295) and without heart disease (39,894,032).
“We learned that in addition to the high and growing prevalence of women with heart disease delivering babies, the reasons are mainly related to increases in women delivering babies with diseases such as cardiomyopathy, adult congenital heart disease, and pulmonary hypertension,” said Dr. Stergiopoulos.
The study also showed that major adverse cardiac events in pregnant women with heart disease increased by nearly 19 percent, and there is a significant and gradual increase in these events for women who have delivered babies and have heart disease. The most common events for women with heart disease were heart failure and arrhythmia.
According to Dr. Stergiopoulos, while a maternal death is a rare event, the findings should impact clinical practices when caring for women with heart disease who are pregnant.
She emphasized that future strategies to mitigate risk in these women include individualized preconception counseling and heart disease risk stratification, meticulous pregnancy follow-up, and a multi-disciplinary approach to labor and delivery that includes a coordinated approach to labor and delivery for those with heart disease that includes specialists from Cardiology, Maternal Fetal Medicine, Obstetrical Anesthesiology and Neonatology.
The study co-authors include Stony Brook faculty from multiple University Departments. Co-authors are Fabio V. Lima, MD, MPH, of the Department of Medicine, Division of Cardiology; Jie Yang, PhD, in the Department of Family, Population and Preventive Medicine; and Jianjin Xu, MS, of the Department of Applied Mathematics and Statistics.
The research was supported in part by the American Heart Association and an American Medical Association Foundation Seed Grant.