Cardiovascular Care for Pregnant Women With Cardiovascular Disease

Abstract

BackgroundCardio-obstetrics refers to a team-based approach to maternal care that includes multidisciplinary collaboration among maternal fetal medicine, cardiology, and others. ObjectivesThis study sought to describe clinical characteristics, maternal and fetal outcomes, and cardiovascular readmissions in a cohort of pregnant women with underlying cardiovascular disease (CVD) followed by a cardio-obstetrics team. MethodsWe identified patients evaluated by our cardio-obstetrics team from January 1, 2010, through December 31, 2019, at a quaternary care hospital in New York City. Information was collected regarding demographics, comorbidities, underlying CVD, medications, maternal and fetal outcomes, and cardiovascular readmissions. Each patient was assigned a Cardiac Disease in Pregnancy (CARPREG) II score based on her clinical characteristics and underlying CVD. ResultsDuring the study period, 306 pregnant women (median age 29 years, 52.9% Hispanic or Latino) with CVD were seen. Most women (74.2%) were insured through Medicaid. The most common forms of CVD included arrhythmia (n = 88, 28.8%), congenital heart disease (n = 72, 23.5%), and cardiomyopathy (n = 72, 23.5%). The median CARPREG II score was 3; 130 patients (42.5%) had a CARPREG II score ≥4. Gestational diabetes occurred in 11.4%, gestational hypertension in 9.5%, and preeclampsia in 12.1% of women. Intensive care unit admission was required for 27 patients (8.8%) during delivery. Median gestational age for delivery was 38 weeks (interquartile range: 37 to 39). Live birth occurred in 98% of pregnancies. One maternal death occurred within a year of delivery in a woman with Eisenmenger syndrome. Following delivery, 30-day readmission rate was 2% and the rate of readmission from 30 to 90 days postpartum was 4.6%. Median follow-up was 2.6 years. ConclusionsIn a population of primarily Medicaid-insured pregnant women managed by a cardio-obstetrics team, maternal outcomes were encouraging and readmission rates following delivery were low. Prospective studies are needed to evaluate the impact of cardio-obstetric models of care on maternal outcomes.