Women with valvular heart disease may be more likely to have adverse obstetric and
cardiovascular complications during pregnancy. Most current recommendations focus
on stenotic lesions with less guidance regarding regurgitant lesions. We aimed to
compare adverse events at delivery for women with various stenotic and regurgitant
valvular diseases. We used the 2016 to 2018 National Inpatient Sample data to compare
demographics, comorbidities, and obstetric and cardiovascular complications during
delivery hospitalizations. After adjusting for clinical and socioeconomic factors,
logistic regression was performed to investigate associations between valvular disease
and outcomes. Among >11.2 million deliveries, 20,349 were in women with valvular disease.
Women with valvular disease were older, had longer length of stays, and higher costs
associated with delivery. They had higher prevalence of underlying cardiovascular
comorbidities compared with women without valvular disease (hypertension: 5.1 vs 0.25%;
pulmonary hypertension: 7.0 vs <0.1%). At delivery, they had higher adjusted odds
of obstetric events including preeclampsia and/or eclampsia (aOR 1.9 [1.8 to 2.2])
and intrapartum/postpartum hemorrhage (aOR 1.4 [1.2 to 1.6]), and cardiovascular events
including peripartum cardiomyopathy (aOR 65 [53 to 78]), pulmonary edema (aOR 17 [13
to 22]), acute ischemic heart disease (aOR 19 [12 to 30]) and arrhythmias (aOR 22
[19 to 27]). There were valve lesion-specific differences in the magnitude of risk
but both stenotic and regurgitant lesions were associated with elevated risk of cardiovascular
complications. In conclusion, pregnant women with stenotic and regurgitant valvular
disease have a greater burden of cardiovascular comorbidities and increased odds of
obstetric and cardiovascular events at delivery. These women may benefit from specialized
care from a Cardio-Obstetrics team.
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Article info
Publication history
Published online: August 24, 2021
Received in revised form:
July 10,
2021
Received:
May 5,
2021
Footnotes
This work was performed at the Johns Hopkins University, Baltimore, MD.
Dr. Minhas was supported by National Heart, Lung, and Blood Institute training grant T32HL007024 and the Johns Hopkins Lou and Nancy Grasmick Endowed Research Fellowship. Dr. Michos is supported by the Amato Fund for Women's Cardiovascular Health Research at Johns Hopkins University.
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