Abstract
Background
One of the most common fetal complications in pregnant women with cardiovascular disease
is a small for gestational age (SGA) neonate, which is associated with a higher risk
of perinatal morbidity/mortality and poor long-term health outcomes. The objective
of this study was to identify cardiac determinants and derive a risk score for clinically
relevant SGA < 5th percentile (SGA-5th).
Methods
A prospective cohort of 1812 pregnancies in women with heart disease were studied.
SGA-5th was the outcome of interest, defined as birth weight < 5th percentile for
gestational age and sex. Multivariable logistic regression analysis was used to identify
predictors for SGA-5th. Based on the regression coefficients, a weighted risk score
was created.
Results
SGA-5th complicated 10% of pregnancies, 11 predictors of SGA-5th were identified,
and each was assigned a weighted score: maternal cyanosis (8), Fontan palliation (7),
smoking (3), moderate or severe valvular regurgitation (3), β-blocker use throughout
pregnancy (4) or only in the 2nd and 3rd trimesters (2), high baseline β-blocker dose
(4), body mass index < 18.5 kg/m2 (3) or 18.5-24.9 kg/m2 (1), Asian/other ethnicity (2), and significant outflow tract obstruction (1). In
the absence of these identified risk factors, the risk of SGA-5th was approximately
4%. Pregnancies with risk scores of 1 had a rate of 5%; 2, 7%; 3, 9%; 4, 12%; 5, 14%;
6, 18%; 7, 23%; 8, 28%; and ≥ 9, 34%.
Conclusions
There are a number of cardiac predictors that are associated with increased risk of
SGA-5th. This is a prognostically important outcome, and consideration should be given
to routinely predicting and modifying the risk whenever possible.
Résumé
Contexte
L'une des complications fœtales les plus courantes chez les femmes enceintes atteintes
d'une maladie cardiovasculaire est la naissance d'un nouveau-né de petit poids pour
l'âge gestationnel (PAG), qui est associée à un risque plus élevé de morbidité/mortalité
périnatale et des effets négatifs à long terme sur la santé. L'objectif de cette étude
était d'identifier les déterminants cardiaques et de dériver un score de risque pour
un PAG < 5e percentile (PAG-5e) cliniquement pertinent.
Méthodes
Une cohorte prospective de 1 812 grossesses chez des femmes souffrant de maladies
cardiaques a été étudiée. L'objectif principal était le PAG-5e, défini comme le poids de naissance <5e percentile pour l'âge gestationnel et le sexe. Une analyse de régression logistique
multivariable a été utilisée pour identifier les prédicteurs du PAG-5e. Un score de risque pondéré a été créé sur la base des coefficients de régression.
Résultats
Le PAG-5e a compliqué 10 % des grossesses, 11 prédicteurs de PAG-5e ont été identifiés, et chacun s'est vu attribuer un score pondéré: cyanose maternelle
(8), intervention de Fontan (7), tabagisme (3), régurgitation valvulaire modérée ou
sévère (3), utilisation de bêtabloquants tout au long de la grossesse (4) ou seulement
au cours des 2e et 3e trimestres (2), dose initiale élevée de bêtabloquants (4), indice de masse corporelle
< 18,5 kg/m2 (3) ou compris entre 18,5-24,9 kg/m2 (1), origine ethnique asiatique/autre (2), et obstruction significative des voies
d'éjection (1). En l'absence de ces facteurs de risque identifiés, le risque de PAG-5e était d'environ 4 %. Les grossesses avec un score de risque de 1 avaient un taux
de 5 % ; 2, 7 %; 3, 9 %; 4, 12 %; 5, 14 %; 6, 18 %; 7, 23%; 8, 28 %; et ≥ 9, 34 %.
Conclusions
Il existe un certain nombre de facteurs prédicteurs cardiaques qui sont associés à
un risque accru de PAG-5e. Il s'agit d'un résultat important sur le plan pronostique, et il convient d'envisager
de prédire et de modifier le risque de manière systématique chaque fois que cela est
possible.
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Article info
Publication history
Published online: April 07, 2021
Accepted:
March 30,
2021
Received:
December 31,
2020
Footnotes
See editorial by Altit et al., pages 1908-1909 of this issue.
See page 1921 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Pregnancies With Maternal Heart Disease: Small Babies, Big Problems?Canadian Journal of CardiologyVol. 37Issue 12
- PreviewThe care of children with heart diseases has tremendously improved in the past few decades. Most children with heart conditions, even those with the most complex conditions, now grow up and reach adulthood, find jobs, fall in love, and hope to have children of their own. Pregnancy comes with its share of joy along with, inevitably, an increased but necessary hemodynamic burden to sustain the life of two beings instead of one. Despite our best efforts, women with acquired and congenital heart diseases often have residual structural heart lesions or ongoing functional cardiac impairments that will chronically increase the cardiovascular load, which may very well worsen during pregnancy.
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