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Pregnancy in women with pre-existent ischaemic heart disease: a systematic review with individualised patient data
  1. Heleen Lameijer1,
  2. Luke J Burchill2,
  3. Lucia Baris3,4,
  4. Titia PE Ruys3,
  5. Jolien W Roos-Hesselink3,
  6. Barbara J M Mulder5,
  7. Candice K Silversides6,
  8. Dirk J van Veldhuisen7,
  9. Petronella G Pieper8
  1. 1 Emergency Medicine, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
  2. 2 Knight Cardiovascular Institute, Oregon Health Science University, Portland, Oregon, USA
  3. 3 Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
  4. 4 Erasmus Medical Center, Rotterdam, The Netherlands
  5. 5 Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
  6. 6 Division of Cardiology, University of Toronto Pregnancy and Heart Disease Program, Mount Sinai Hospital and Univeristy Health Network, Toronto, Ontario, Canada
  7. 7 Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
  8. 8 Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Heleen Lameijer, Medisch Centrum Leeuwarden, Leeuwarden 8934 AD, The Netherlands; heleen.lameijer1{at}znb.nl

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.

  • ischaemic heart disease
  • coronary artery disease
  • pregnancy

https://doi.org/10.1136/heartjnl-2018-314364

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    Footnotes

    • Contributors HL collected and analysed all literature data and wrote the manuscript, supervised by PGP and DJvV. LJB, CKS, LB, TPER and JWR-H collected data used in this review and supervised the manuscript writing. BJMM was asked to supervise the review process including the writing of the manuscript as an independent expert in the field. HL and PGP are being responsible for the overall content as guarantor(s).

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.