Wald Rachel M, Silversides Candice K, Kingdom John, Toi Ants, Lau Cathy S, Mason Jennifer, Colman Jack M, Sermer Mathew, Siu Samuel C
Pregnancy and Heart Disease Research Program and the Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada (R.M.W., C.K.S., C.S.L., J.M.C., S.C.S.) Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada (R.M.W., C.K.S., J.K., J.M., J.M.C., M.S., S.C.S.) Joint Department of Medical Imaging, University of Toronto, Ontario, Canada (R.M.W., A.T.).
Pregnancy and Heart Disease Research Program and the Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada (R.M.W., C.K.S., C.S.L., J.M.C., S.C.S.) Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada (R.M.W., C.K.S., J.K., J.M., J.M.C., M.S., S.C.S.).
J Am Heart Assoc. 2015 Nov 23;4(11):e002414. doi: 10.1161/JAHA.115.002414.
The mechanistic basis of the proposed relationship between maternal cardiac output and neonatal complications in pregnant women with heart disease has not been well elucidated.
Pregnant women with cardiac disease and healthy pregnant women (controls) were prospectively followed with maternal echocardiography and obstetrical ultrasound scans at baseline, third trimester, and postpartum. Fetal/neonatal complications (death, small-for-gestational-age or low birthweight, prematurity, respiratory distress syndrome, or intraventricular hemorrhage) comprised the primary study outcome. One hundred and twenty-seven women with cardiac disease and 45 healthy controls were enrolled. Neonatal events occurred in 28 pregnancies and were more frequent in the heart disease group as compared with controls (n=26/127 or 21% versus n=2/45 or 4%; P=0.01). Multiple complications in an infant were counted as a single outcome event. Neonatal complications in the heart disease group were small-for-gestational-age/low birthweight (n=18), prematurity (n=14), and intraventricular hemorrhage/respiratory distress syndrome (n=5). Preexisting obstetric risk factors (P=0.003), maternal cardiac output decline from baseline to third trimester (P=0.017), and third trimester umbilical artery Doppler abnormalities (P<0.001) independently predicted neonatal complications and were incorporated into a novel risk index in which 0, 1, and >1 predictor corresponded to expected complication rates of 5%, 30%, and 76%, respectively.
Decline in maternal cardiac output during pregnancy and abnormal umbilical artery Doppler flows independently predict neonatal complications. These findings will enhance the identification of higher risk pregnancies that would benefit from close antenatal surveillance.
患有心脏病的孕妇，其母体心输出量与新生儿并发症之间的假定关系的机制基础尚未得到充分阐明。
前瞻性地对患有心脏病的孕妇和健康孕妇（对照组）在基线期、孕晚期及产后进行母体超声心动图和产科超声扫描。胎儿/新生儿并发症（死亡、小于胎龄儿或低出生体重、早产、呼吸窘迫综合征或脑室内出血）构成主要研究结局。共纳入127例患有心脏病的女性和45例健康对照。28例妊娠出现新生儿事件，与对照组相比，心脏病组更常见（26/127或21% 对比2/45或4%；P = 0.01）。婴儿的多种并发症计为单个结局事件。心脏病组的新生儿并发症为小于胎龄儿/低出生体重（18例）、早产（14例）和脑室内出血/呼吸窘迫综合征（5例）。既往产科危险因素（P = 0.003）、母体心输出量从基线期到孕晚期的下降（P = 0.017）以及孕晚期脐动脉多普勒异常（P < 0.001）可独立预测新生儿并发症，并被纳入一个新的风险指数，其中0、1和>1个预测因素分别对应预期并发症发生率5%、30%和76%。
孕期母体心输出量下降和脐动脉多普勒血流异常可独立预测新生儿并发症。这些发现将有助于识别可从密切产前监测中获益的高风险妊娠。
