Clinical course and short-term outcomes of pregnancy in a high-risk population of women with cardiovascular disease

Ailis Ceara Haney (Heidelberg)1, I. Hörbrand (Heidelberg)1, D. Siry (Heidelberg)1, N. Frey (Heidelberg)1, P. Ehlermann (Heidelberg)1, J. Beckendorf (Heidelberg)1

1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland



Pregnancy poses hemodynamic challenges which healthy women can usually manage without problems. However, for women with cardiovascular disease this can mean increased risk for complications, both for the mother and the fetus. On top of that, the long-term risk of cardiovascular disease was shown to be increased for women with complications during pregnancy. The guidelines of the European Society of Cardiology recommend treating high-risk patients in specialized centres by an interdisciplinary pregnancy heart team. In a team-based approach, the Pregnancy Heart Team was founded at University Hospital Heidelberg, in order to establish specific structures of communication and responsibility.



A registry of all patients treated by the Pregnancy Heart Team was established in 2022. All patients treated by the Pregnancy Heart Team between November 2022 and October 2023 were analyzed. Patients with pregnancy-associated cardiovascular disease were included as well as patients with preexisting cardiovascular disease wishing to become pregnant or undergoing pregnancy. Patients were evaluated clinically, by echocardiography and with lab work before pregnancy, during each trimester and in the postpartum period, when feasible. 



In total 36 women (mean age 34±6 years) were prospectively included in the registry. 17 patients (47.2 %) were classified as mWHO ≥ III. 16 patients (44.4 %) with preexisting (pregnancy-associated) cardiovascular disease were managed throughout pregnancy and delivery. 8 patients (22.2 %) developed pregnancy-associated cardiovascular diseases such as peripartum cardiomyopathy or spontaneous coronary artery dissection. Preliminary data shows that mean left-ventricular ejection fraction remained stable during pregnancy with a non-significant trend towards lower values postpartum. Cardiac biomarkers such as high-sensitivity troponin T and NT-pro-BNP showed a non-significant trend towards increased values in the third trimester and postpartum. Adverse maternal outcomes occurred in 11 patients (30.5 %), including preterm premature rupture of membranes (13.8%), gestational hypertension (8.3%), gestational diabetes (5.6%), preeclampsia/eclampsia (8.3%) and delivery-associated complications (8.3%). Fetal complications included macrosomia (11.1%) or intrauterine growth retardation (8.3%).



Our preliminary data within a high-risk population of women with cardiovascular disease demonstrated that whilst left-ventricular ejection fraction remained stable throughout pregnancy, a significant amount of patients experienced adverse pregnancy outcomes. As recent studies have shown, interpretation of standard parameters such as cardiac biomarkers is not fully understood during pregnancy, especially in women with pre-existing cardiovascular disease. Further analyses in the future may aid to understand prognostic implications of cardiac biomarkers during pregnancy.


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