Abstract 10309: Pregnancy Outcomes in Women with Hypertrophic Cardiomyopathy

Abstract

Introduction: Hypertrophic cardiomyopathy (HCM) is a genetic disorder often complicated by heart failure, embolic stroke, and sudden cardiac death. Pregnancy causes hemodynamic changes which may be deleterious in patients with HCM. Existing cohort studies of maternal and fetal outcomes of pregnant patients with HCM are limited by small sample sizes. We performed a systematic review of maternal and fetal outcomes of pregnancy in patients with established HCM. Methods: We searched MEDLINE, EMBASE, and Cochrane Library databases for studies reporting maternal or fetal outcomes in pregnant patients with HCM. The primary outcomes were maternal death, stillbirth, and fetal death. Secondary maternal outcomes included: sustained ventricular tachycardia (VT), any VT (including sustained and non-sustained), atrial fibrillation (AF), syncope, caesarean delivery, and pre-eclampsia or eclampsia. The secondary fetal outcome was preterm birth. We used a random effects model to determine pooled incidences of outcomes. Results: A total of 18 studies with 5236 pregnancies were included. The incidence of maternal death was 0.2%. Similarly, the incidence of neonatal death was 0.2%. The incidence of maternal and neonatal death was too low across studies to derive pooled estimates. The rate of stillbirth was low at 1% (95% CI, 0-3%) and rate of preterm birth was 22% (95% CI, 18-25%). The rates of sustained VT, any VT, AF, heart failure, and syncope were 1% (0-1%), 6% (4-8%), 4% (2-6%), 5% (3-8%), and 9% (3-14%), respectively. Postpartum hemorrhage, preeclampsia or eclampsia, and cesarean section complicated 2% (1-4%), 4% (2-6%), and 43% (32-54%) of pregnancies, respectively. Conclusions: Women with HCM looking to become pregnant can be reassured that the risk of death, stillbirth, or neonatal demise are low. However, they are at risk for several non-fatal cardiac and pregnancy related complications.