Preferences of Pregnant Women With Cardiac Disease for Maternal-Fetal Outcomes Related to Their Pregnancies [20N

Abstract

INTRODUCTION: The trade-offs pregnant women with cardiac disease are willing to make in order to optimize pregnancy outcomes is undetermined. This study aimed to elicit preferences of these women for maternal and fetal outcomes related to cardiac disease in pregnancy. METHODS: A cross-sectional study was conducted on pregnant women with cardiac disease. participants were then presented with 19 vignettes describing combined maternal and fetal outcomes related to cardiac disease. Maternal outcomes included cardiac events (arrhythmias and cardiac failure), blood clots, a combination of the two and no cardiac events; while fetal outcomes included perfect health, minor or major malformations, small-for-gestational-age (SGA) infants and fetal demise. Participants were asked to assign values to these outcomes on a visual analogue scale (VAS), by the standard gamble (SG) and time trade-off (TTO) methods. Utility values (preferences) for each state obtained from all three methods were presented on a scale of 0-100. RESULTS: 34 pregnant women with cardiac disease completed the interviews. The median age was 31.5 [29-34] years and the median gestational age was 24 [19-35] weeks. Participants did not perceive combinations of maternal cardiac events as more severe than a solitary event. Also, they regarded SGA as more severe outcome than minor congenital malformations, but valued major malformations as bad as fetal demise. CONCLUSION: This study is the first to obtain preferences of pregnant women with cardiac disease for combined maternal and fetal outcomes related to their condition. These preferences should be incorporated in clinical decision-making.