Predictors of maternal cardiac complications in pregnant women with severe cardiac valve disease

Abstract

Maternal mortality in general has decreased in the past decade, but over the same period, cardiac maternal death has not declined. In emerging countries, rheumatic valve disease is the most common cardiac disease in pregnant women. We conducted this study in order to determine predictors of cardiac complication in such pregnant condition. It was a retrospective study including all pregnant women with at least one severe cardiac valve disease and who gave birth in our hospital between 2010 and 2017. Maternal cardiac event was defined as cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, endocarditis. We included 60 pregnancies in 54 women during the study period. The mean age was 32.55 ± 5.6 years, the mean gestity was 2.8 ± 1.6 (1–9), the valvular disease was discovered during pregnancy in 45%, a multiple valve disease was diagnosed in 47% of cases. The most frequent severe cardiac valve disease was mitral stenosis (65% of the cases). Cardiac complications occurred in 37 patients (61%). On Univariate analysis, the predictors of such complications was gestity (3.16 ± 1.8 versus 2.21 ± 1.16, P = 0.038), parity (2.45 ± 1.21 varsus 1.69 ± 0.87, P = 0.01), discovery of the valvylar disease during the pregnancy ( P = 0.039), mitral stenosis (86.5% versus 47.8%, P = 0.001), atrial fibrillation (48.6% versus 21.7%, P = 0.37, and systolic pulmonary pressure (57.29 ± 15.8 versus 40.39 ± 9.7, P < 0.001), but on multivariate analysis, the independent factors of cardiac complications was severe mitral stenosis ( P = 0.035, OR = 6.8, 95% CI (1.14–41.05), pulmonary systolic pressure (OR = 1.08, 95% CI (1.015–1.14), parity ( P = 0.023, OR = 2.41, 95% CI (1.12–5.16). Severe Mitral stenosis was the main cause of cardiac complication in pregnant cardiac woman. The percutaneous mitral dilatation could improve the maternal prognosis and should be attempted when anatomic data are in favor.