Postpartum cardiovascular outcomes among pregnant women with known heart diseases
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20261249Keywords:
Postpartum cardiovascular outcomes, Heart disease in pregnancy, Preconceptional counsellingAbstract
Background: Maternal heart disease has emerged as a major threat to safe motherhood and women’s long-term cardiovascular health, and the postpartum period is a time of heightened risk for cardiovascular disease-related maternal morbidity and mortality. Therefore, the present study aimed to evaluate the effect of preconceptional counselling on postpartum cardiovascular outcomes among pregnant women with known heart disease in Bangladesh.
Methods: This hospital-based cohort study was conducted at the Department of Obstetrics and Gynaecology, Fetomaternal Medicine Unit, Dhaka Medical College Hospital (DMCH); the Department of Fetomaternal Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU); and the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from February 2020 to March 2021, including 73 postpartum women with heart disease. Demographic, obstetric, cardiac data, NYHA class, preconceptional counselling, and maternal outcomes were collected and analyzed using SPSS v26 (Chi-square, p<0.05).
Results: Among 73 pregnant women (39 known, 34 incidentally diagnosed), younger age, lower socioeconomic status, education, and parity differed significantly between groups (p<0.001). LUCS was more frequent in known cases, vaginal delivery in incidental cases (p<0.001). Rheumatic heart disease predominated (41/73), and NYHA class I was higher in known cases (p<0.001). Cardiac events occurred in 45.2%, mostly in incidental cases (63.6% vs. 36.4%, p=0.010; RR=1.96), particularly in multiparas; outcomes did not vary by disease type.
Conclusions: Awareness and early diagnosis of maternal heart disease, combined with timely multidisciplinary care, significantly reduce postpartum cardiovascular complications.
References
Sayeeda S, Wahid F, Begum F, Zaman MM. A two years study on pregnant women with cardiac disease in a tertiary care centre. Bangladesh J Obstet Gynaecol. 2008;23(1):8-14.
Bhide A. Arias’ practical guide to high-risk pregnancy and delivery: a South Asian perspective. 2nd ed. Philadelphia: Elsevier. 2015.
Nguyen MT, Bui VN, Le TH, Vo HL, Nguyen SAH, Trinh TTH, et al. Pregnancy with heart disease: maternal outcomes and risk factors for fetal growth restriction. Int J Environ Res Public Health. 2019;16(12):2075.
Roos-Hesselink J, Baris L, Johnson M, De Backer J, Otto C, Marelli A, et al. Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry of Pregnancy And Cardiac disease (ROPAC). Eur heart J. 2019;40(47):3848-55.
Wenger NK, Speroff L, Packard B. Cardiovascular health and disease in women. N Eng J Med. 1993;329(4):247-56.
Gnanaraj JP, Surendran A. Counselling and pregnancy outcomes in women with congenital heart disease-current status and gap analysis from madras medical college pregnancy and cardiac disease (M-PAC) registry. Int J Cardiol Congenit Heart Dis. 2021;5:100207.
Gahlot K, Singh PP, Pandey K. Pregnancy outcome in women with heart disease at a tertiary referral teaching center in Northern India. Int J Reprod Contracept Obstet Gynecol. 2016;5(9):3056-60.
Koirala PS. Obstetric outcome in patients with rheumatic heart disease: experience of a tertiary hospital. Nepal Heart J. 2017;14(2):31-4.
Bhatla N, Lal S, Behera G, Kriplani A, Mittal S, Agarwal N, et al. Cardiac disease in pregnancy. Int J Gynecol Obstet. 2003;82(2):153-9.
National Institute of Population Research and Training (NIPORT). Miscellaneous information. Dhaka: Government of the People’s Republic of Bangladesh. Available at: https://www.niport.gov.bd/site/view/miscellaneous_info. Accessed on 16 February 2026.
Watkins DA, Sebitloane M, Engel ME, Mayosi BM. The burden of antenatal heart disease in South Africa: a systematic review. BMC Cardiovas disord. 2012;12(1):23.
Khanna R, Chandra D, Yadav S, Sahu A, Singh N, Kumar S, et al. Maternal and fetal outcomes in pregnant females with rheumatic heart disease. Indian heart J. 2021;73(2):185-9.
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy: the task force for the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur heart J. 2018;39(34):3165-241.
Cauldwell M, Steer PJ, Swan L, Patel RR, Gatzoulis MA, Uebing A, et al. pre-pregnancy counselling for women with heart disease: a prospective study. Int J cardiol. 2017;240:374-8.
Diao M, Kane A, Ndiaye MB, Mbaye A, Bodian M, Dia MM, et al. Pregnancy in women with heart disease in sub-Saharan Africa. Arch cardiovasc dis. 2011;104(7):370-4.
Ruys TP, Cornette J, Roos-Hesselink JW. Pregnancy and delivery in cardiac disease. J cardiol. 2013;61(2):107-12.
Roos-Hesselink JW, Budts W, Walker F, De Backer JF, Swan L, Stones W, et al. Organisation of care for pregnancy in patients with congenital heart disease. Heart. 2017;103(23):1854-9.
Furenäs E, Eriksson P, Wennerholm UB, Dellborg M. Cardiac complications during pregnancy related to parity in women with congenital heart disease. Cardiology. 2020;145(8):533-42.
American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 212: pregnancy and heart disease. Obstet gynecol. 2019;133(5):e320-56.
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