Pregnancy in women with cardiac disease: Management and outcomes in a European cardio-obstetric team

Cardiovascular (CV) diseases are currently the leading cause of maternal death in developed countries. Although the creation of multidisciplinary cardio-obstetric teams is recommended with a view to improve the management of pregnant women with heart disease, little objective data exist to support the interest of this approach. We aimed to describe the characteristics, management and outcomes of patients managed in a cardio-obstetric team from a tertiary center. We included every pregnant patient with history of heart disease managed by the cardio obstetric team in our Lille University Hospital tertiary center between June 2017 and December 2019. We collected data about their clinical history, pregnancy and childbirth. Severe CV events (death, heart failure, acute coronary syndrome, stroke) occurring during their pregnancy and the following year were collected. We included 209 pregnancies, in 202 consecutive patients, aged 31 years [27;35.2]. Heart disease was predominantly valvular (37.8%), rhythmic (29.7%), and congenital (23%). 45% were classified mWHO > II, 66.4% had CARPREG II score ≥ 2 (Fig. 1). Eighty (38.2%) patients were on anticoagulants or antiplatelet therapy. The rate of great prematurity was 2.9%. 80 patients (38.3%) delivered by cesarean section, 29 (13.9%) for maternal CV risk indication. Sixteen patients (7.7%) presented severe post-partum hemorrhage. Fifteen (7.1%) severe CV outcomes occurred peripartum, and 10 during the one-year follow-up (4.7%), in 21 patients, i.e., 10% of the patients. 62% occurred in patients without any follow-up before their pregnancy. This is the first description of the management and outcome of a European cohort of pregnant patients with heart disease within a structured multidisciplinary cardio-obstetric team. This type of approach seems encouraging as we collected relatively low rate of outcomes despite a high-risk profile population. However, the majority of events still occurred in mothers without any follow-up before their pregnancy. Large-scale education programs are required.