Isogai Toshiaki, Matsui Hiroki, Tanaka Hiroyuki, Kohyama Akira, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Heart Vessels. 2018 Aug;33(8):918-930. doi: 10.1007/s00380-018-1137-1. Epub 2018 Feb 17.
Although the number of pregnancies in women with cardiac disease is increasing worldwide, there are few data concerning their clinical characteristics and peripartum outcomes. Using the Diagnosis Procedure Combination database between 2008 and 2014 in Japan, we retrospectively identified pregnant women who underwent high-risk delivery due to obstetric or non-obstetric comorbidities. We classified eligible women into those with pre-existing cardiac disease (cardiac disease group) and those with non-cardiac comorbidities (non-cardiac disease group) and compared their characteristics and peripartum outcomes. Of 94,364 women undergoing high-risk delivery at 556 hospitals, 857 (0.91%) had pre-existing cardiac disease (302, congenital heart disease; 190, arrhythmia; 176, valvular heart disease; 120, ischemic heart disease; 65, cardiomyopathy; 4, pericardial disease). Women in the cardiac disease group were more likely to be treated at university hospitals (51.1 versus 28.6%; p < 0.001) and in intensive care units (33.5 versus 18.8%; p < 0.001) than those in the non-cardiac disease group. The proportion of cesarean deliveries was 69.4% (emergency, 28.4%; elective, 41.1%) in the cardiac disease group and 73.4% (emergency, 38.4%; elective, 35.0%) in the non-cardiac disease group. Epidural analgesia during vaginal delivery was used significantly more frequently in the cardiac disease than non-cardiac disease group (15.6 versus 2.3%; p < 0.001). Heart failure occurred more frequently in the cardiac disease than the non-cardiac disease group (10.2 versus 0.3%; p < 0.001). In cardiac subgroup comparisons, heart failure occurred more frequently in women with congenital heart disease (12.3%), valvular heart disease (12.5%), or cardiomyopathy (12.3%) than in women with arrhythmia (6.3%) or ischemic heart disease (5.8%). Multivariable logistic regression analysis showed a significant positive association between pre-existing cardiac disease and risk of heart failure (adjusted odds ratio, 24.7; 95% confidence interval, 17.6-34.6; p < 0.001). No woman in the cardiac disease group died, whereas 18 women (0.02%) in the non-cardiac disease group did (p = 1.000). These findings suggest that pregnant women with pre-existing cardiac disease are at a higher risk of heart failure during the peripartum period than those with non-cardiac comorbidities.
尽管全球患有心脏病的女性怀孕人数在增加，但关于她们的临床特征和围产期结局的数据却很少。利用日本2008年至2014年的诊断程序组合数据库，我们回顾性地确定了因产科或非产科合并症而接受高危分娩的孕妇。我们将符合条件的女性分为患有先天性心脏病（心脏病组）和患有非心脏合并症（非心脏病组），并比较了她们的特征和围产期结局。在556家医院接受高危分娩的94364名女性中，857名（0.91%）患有先天性心脏病（302例）、心律失常（190例）、瓣膜性心脏病（176例）、缺血性心脏病（120例）、心肌病（65例）、心包疾病（4例）。与非心脏病组相比，心脏病组的女性更有可能在大学医院接受治疗（51.1%对28.6%；p<0.001）和在重症监护病房接受治疗（33.5%对18.8%；p<0.001）。心脏病组剖宫产的比例为69.4%（急诊，28.4%；择期，41.1%），非心脏病组为73.4%（急诊，38.4%；择期，35.0%）。心脏病组在阴道分娩期间使用硬膜外镇痛的频率明显高于非心脏病组（15.6%对2.3%；p<0.001）。心脏病组发生心力衰竭的频率高于非心脏病组（10.2%对0.3%；p<0.001）。在心脏亚组比较中，先天性心脏病（12.3%）、瓣膜性心脏病（12.5%）或心肌病（12.3%）的女性发生心力衰竭的频率高于心律失常（6.3%）或缺血性心脏病（5.8%）的女性。多变量逻辑回归分析显示，先天性心脏病与心力衰竭风险之间存在显著正相关（调整后的优势比，24.7；95%置信区间，17.6 - 34.6；p<0.001）。心脏病组没有女性死亡，而非心脏病组有18名女性（0.02%）死亡（p = 1.000）。这些发现表明，患有先天性心脏病的孕妇在围产期发生心力衰竭的风险高于患有非心脏合并症的孕妇。
