Results from world's first registry of pregnancy and heart disease

September 11, 2012

Results from the world's first registry of pregnancy and heart disease have shown that most women with heart disease can go through pregnancy and delivery safely, so long as they are adequately evaluated, counselled and receive high quality care.

However, this is not always the case: women and babies in developing countries are more likely to die than those in developed countries where women are more likely to access better care and counselling before and during pregnancy; women with cardiomyopathy, a disease of the heart muscle, are also more affected by pregnancy. The findings are published online today (Wednesday) in the European Heart Journal [1].

In 2007 the European Society of Cardiology set up the European Registry on Pregnancy and Heart Disease because deaths during pregnancy among women with heart disease were rising in western countries and it is a major cause of maternal death, yet there was limited understanding about the consequences of heart disease on pregnancy outcome and the best ways of caring for these women. Overall, about 0.9% of pregnant women have some form of heart disease.

Between 2007 and 2011, 60 hospitals in 28 countries enrolled 1321 pregnant women with heart disease to the registry, and collected data on all aspects of the pregnancy and delivery and the mothers' heart condition and medication use.

Congenital heart disease (CHD) was the most common, with 66% of the women having the condition, which is a problem with the heart's structure and function that is present at birth; 25% of women had valvular heart disease (VHD), a disease of one or more of the valves in the heart; 7% had cardiomyopathy (CMP); and 2% had ischaemic heart disease (IHD), where insufficient blood reaches the heart and can result in problems such as heart attack.

There were clear differences in outcome for mothers and babies by type of heart disease. Women with CMP were more likely to die or to suffer from serious problems such as heart failure and irregular heart beat (ventricular arrhythmias) than women with other conditions. Women with CHD had relatively good outcomes compared to women with other conditions, probably because most of these patients were diagnosed and treated either soon after birth, or long before becoming pregnant, and had benefited from improved treatments and pre-pregnancy counselling.

There were significant differences in outcome between developed and developing countries, although the authors warn that these figures need to be treated with some caution because of the differences in the numbers of women in the different countries. In developing countries 3.9% of women in this study died compared to 0.6% of women in developed countries, and 6.5% of babies died compared to 0.9% in developed countries.

Overall, the study showed that pregnancy in patients with heart disease resulted in one percent of mother dying, which was 100 times higher than in the normal population of pregnant women. Among women with heart disease 10 in every 1000 died, compared to less than one per 10,000 in the European population of pregnant women without a heart condition. Death of the foetus during pregnancy was five times higher (17 per 1000 dying compared to 3.5 per 1000 of the normal population), and death of the baby within 30 days of birth was 1.5 times higher (6.4 per thousand dying compared to four per 1000 in the normal population). However, these figures varied enormously between developed and developing countries.

Professor Jolien Roos-Hesselink, who is Director of Adult Congenital Heart Disease Programme at the Erasmus Medical Centre in Rotterdam, The Netherlands, and who led the research together with Professor Roger Hall from Norwich Medical School, University of East Anglia (UK), said: "The most striking findings from this study were these differences between different parts of the world, with worse outcomes in developing countries. Our Egyptian colleagues explained there are important cultural factors influencing the results. For instance, it is very important in Egypt to have a child in order to deserve respect. Therefore, women will become pregnant there although they are aware of the very high risks.

"The differences in outcome between groups of women with different conditions was also striking, particularly the higher mortality in cardiomyopathy patients, where 2.4% of them died compared to just 0.007% in the normal population."

The problem with cardiomyopathy is that, because the heart muscle is diseased, there is an increased risk of heart failure during pregnancy as the heart has to work harder. Professor Mark Johnson, one of the paper's authors and Chair in Obstetrics at Imperial College London (UK), explained: "The heart has to pump 50% more blood than usual during pregnancy, a significant increase in work load, which exacerbates an underlying cardiac disease or, in some cases, will bring out a hitherto unrecognised problem."

The authors conclude that "the vast majority of patients can go safely through pregnancy and delivery as long as adequate pre-pregnancy evaluation and specialised high-quality are during pregnancy and delivery are available." However, they point out that there are important differences.

Professor Roos-Hesselink said: "These data show large differences between groups and that some groups do very well, while others do not, and especially patients with a cardiomyopathy are at risk and should be counselled and followed carefully. In addition, foetal outcome, as well as maternal outcome, can be hampered and influenced by the mother's disease."

Professor Johnson said: "This study gives us the essential basic information about the size and extent of the problems facing women with pre-existing heart disease during pregnancy. This will allow us to start to design interventional studies in high-risk groups with the aim of improving their outcome."

[1] "Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology," by Jolien W. Roos-Hesselink et al. European Heart Journal. doi:10.1093/eurheartj/ehs270

[2] More information on the Pregnancy and Heart Disease Registry can be found here:

European Society of Cardiology

Related Heart Disease Articles from Brightsurf:

Cellular pathway of genetic heart disease similar to neurodegenerative disease
Research on a genetic heart disease has uncovered a new and unexpected mechanism for heart failure.

Mechanism linking gum disease to heart disease, other inflammatory conditions discovered
The link between periodontal (gum) disease and other inflammatory conditions such as heart disease and diabetes has long been established, but the mechanism behind that association has, until now, remained a mystery.

New 'atlas' of human heart cells first step toward precision treatments for heart disease
Scientists have for the first time documented all of the different cell types and genes expressed in the healthy human heart, in research published in the journal Nature.

With a heavy heart: How men and women develop heart disease differently
A new study by researchers from McGill University has uncovered that minerals causing aortic heart valve blockage in men and women are different, a discovery that could change how heart disease is diagnosed and treated.

Heart-healthy diets are naturally low in dietary cholesterol and can help to reduce the risk of heart disease and stroke
Eating a heart-healthy dietary pattern rich in vegetables, fruits, whole grains, low-fat dairy products, poultry, fish, legumes, vegetable oils and nuts, which is also limits salt, red and processed meats, refined-carbohydrates and added sugars, is relatively low in dietary cholesterol and supports healthy levels of artery-clogging LDL cholesterol.

Pacemakers can improve heart function in patients with chemotherapy-induced heart disease
Research has shown that treating chemotherapy-induced cardiomyopathy with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can significantly improve patient outcomes.

Arsenic in drinking water may change heart structure raising risk of heart disease
Drinking water that is contaminated with arsenic may lead to thickening of the heart's main pumping chamber in young adults, according to a new study by researchers at Columbia University Mailman School of Public Health.

New health calculator can help predict heart disease risk, estimate heart age
A new online health calculator can help people determine their risk of heart disease, as well as their heart age, accounting for sociodemographic factors such as ethnicity, sense of belonging and education, as well as health status and lifestyle behaviors.

Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure
Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.

Heart failure: The Alzheimer's disease of the heart?
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.

Read More: Heart Disease News and Heart Disease Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to