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Original research article
Maternal and neonatal outcomes in women with history of coronary artery disease
  1. Matthew Cauldwell1,
  2. Philip J Steer1,
  3. Katherine von Klemperer2,
  4. Mandeep Kaler2,
  5. Sarah Grixti3,
  6. Joanna Hale4,
  7. Josie O'Heney5,
  8. David Warriner6,
  9. Stephanie Curtis7,
  10. Aarthi R Mohan8,
  11. Samuel Dockree9,
  12. Lucy Mackillop9,
  13. Catherine E G Head10,
  14. Monique Sterrenberg11,
  15. Suzanne Wallace12,
  16. Leisa J Freeman13,
  17. Gemma Patridge14,
  18. Jelle H Baalman15,
  19. Fionnuala M McAuliffe15,
  20. Margaret Simpson16,
  21. Niki Walker17,
  22. Joanna Girling18,
  23. Farah Siddiqui19,
  24. Aidan P Bolger20,
  25. Foteini Bredaki21,
  26. Fiona Walker2,
  27. Sarah Vause22,
  28. Michael A Gatzoulis23,
  29. Mark R Johnson24,
  30. Anna Roberts25
  1. 1Chelsea and Westminster Hospital, Imperial College London, London, UK
  2. 2Barts Health NHS Trust, London, UK
  3. 3Royal London Hospital, London, UK
  4. 4Princess Anne Hospital, Southampton, UK
  5. 5Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
  6. 6Leeds Teaching Hospitals NHS Trust, Leeds, UK
  7. 7Bristol Heart Institute, Bristol, Bristol, UK
  8. 8University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  9. 9Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  10. 10Adult Congenital Heart Disease Service, Guys and St Thomas NHS Foundation Trust, London, UK
  11. 11Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  12. 12Obstetrics, Nottingham University Hospitals, Nottingham, UK
  13. 13Cardiology, Norfolk and Norwich University NHS Hospital, Norwich, UK
  14. 14Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  15. 15UCD Perinatal Research Institute, Dublin, UK
  16. 16Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Clydebank, UK
  17. 17Adult Congenital Heart Disease, Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, UK
  18. 18West Middlesex University Hospital, Isleworth, UK
  19. 19Obstetrics, Leicester Royal Infirmary, Leicester, UK
  20. 20East Midlands Congenital Heart Centre, Glenfield Hospital, University Hospitals of Leciester, Leicester, UK
  21. 21University College London Medical School, London, UK
  22. 22Obstetrics, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  23. 23Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
  24. 24Imperial College London, Chelsea and Westminster Hospital, London, UK
  25. 25Central Manchester University Hospitals NHS Foundation Trust Wilmslow Park Office, Manchester, UK
  1. Correspondence to Dr Matthew Cauldwell, Chelsea and Westminster Hospital, Imperial College London, London SW10 9NH, UK; mrc100{at}ic.ac.uk

Abstract

Background Pregnancy outcomes in women with pre-existing coronary artery disease (CAD) are poorly described. There is a paucity of data therefore on which to base clinical management to counsel women, with regard to both maternal and neonatal outcomes.

Method We conducted a retrospective multicentre study of women with established CAD delivering at 16 UK specialised cardiac obstetric clinics. We included pregnancies of 24 weeks’ gestation or more, delivered between January 1998 and October 2018. Data were collected on maternal cardiovascular, obstetric and neonatal events.

Results 79 women who had 92 pregnancies (94 babies including two sets of twins) were identified. 35.9% had body mass index >30% and 24.3% were current smokers. 18/79 (22.8%) had prior diabetes, 27/79 (34.2%) had dyslipidaemia and 21/79 (26.2%) had hypertension. The underlying CAD was due to atherosclerosis in 52/79 (65.8%), spontaneous coronary artery dissection (SCAD) in 11/79 (13.9%), coronary artery spasm in 7/79 (8.9%) and thrombus in 9/79 (11.4%).

There were six adverse cardiac events (6.6% event rate), one non-ST elevation myocardial infarction at 23 weeks’ gestation, two SCAD recurrences (one at 26 weeks’ gestation and one at 9 weeks’ postpartum), one symptomatic deterioration in left ventricular function and two women with worsening angina. 14% of women developed pre-eclampsia, 25% delivered preterm and 25% of infants were born small for gestational age.

Conclusion Women with established CAD have relatively low rates of adverse cardiac events in pregnancy. Rates of adverse obstetric and neonatal events are greater, highlighting the importance of multidisciplinary care.

  • pregnancy
  • ischaemic heart disease
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Footnotes

  • Contributors MC conceived the idea for the study. MC, KvK, MK, SG, JH, JO, DW, SC, ARM, SD, MSt, SW, GP, JHB, MSi, JG, FS, FB all collated data for the study. PJS analysed the data with MC. MC, PJS, AR and MRJ wrote the first draft. CH, LF, DW, FMM, NW, AB, FW, SV, MG, PJS, all provided revisions to the first draft. All authors approved the final draft.

  • 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.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available on reasonable request.

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