Nii Masafumi, Tanaka Hiroaki, Tanaka Kayo, Katsuragi Shinji, A Kamiya Chizuko, Shiina Yumi, Niwa Koichiro, Ikeda Tomoaki
Department of Obstetrics and Gynecology, Mie University School of Medicine, Japan.
Department of Obstetrics and Gynecology, Sakakibara Heart Institute, Japan.
Intern Med. 2020;59(9):1119-1124. doi: 10.2169/internalmedicine.3016-19. Epub 2020 May 1.
Objective Cardiovascular disease increases the risk of maternal mortality. This study examined the risk factors for cardiovascular events in pregnant women with cardiovascular disease. Methods This was a case-control study conducted in 2 phases at Japanese maternal and fetal care centers. The primary survey, using an interviewer-administered questionnaire, investigated whether the institutions had managed pregnant women with cardiovascular disease from April 2014 to March 2016. From 424 individual facilities surveyed, 135 facilities were found to have experience in managing pregnant women. In the secondary survey, the 135 institutions were asked to complete a web-based questionnaire, which collected detailed clinical information about cases, including cardiovascular disease, cardiovascular events, maternal background, and the perinatal outcome. Results Information on 302 pregnant women with cardiovascular disease was collected. None of the 302 patients died. There were 25 women with cardiovascular events (cardiovascular event group) and 277 women without cardiovascular events (non-cardiovascular event group); the two groups were compared. No significant differences were found in the perinatal outcomes. Medication use before pregnancy was identified as a risk factor for cardiovascular events (adjusted odds ratio, 23.28; 95% confidence interval, 8.15-66.47; p<0.001). In pregnant women with cardiovascular disease, New York Heart Association (NYHA) functional class II or III before pregnancy was associated with a higher risk of cardiovascular events in comparison to NYHA functional class I (p<0.001 for both). Conclusion Medication use before pregnancy and NYHA functional class >I were risk factors for cardiovascular events in pregnant women with cardiovascular disease.
目的 心血管疾病会增加孕产妇死亡风险。本研究调查了患有心血管疾病的孕妇发生心血管事件的风险因素。方法 这是一项在日本母婴护理中心分两个阶段进行的病例对照研究。初步调查采用访谈式问卷，调查各机构在2014年4月至2016年3月期间是否管理过患有心血管疾病的孕妇。在接受调查的424家机构中，发现有135家机构有管理孕妇的经验。在二次调查中，要求这135家机构完成一份基于网络的问卷，该问卷收集了有关病例的详细临床信息，包括心血管疾病、心血管事件、孕产妇背景和围产期结局。结果 收集了302名患有心血管疾病的孕妇的信息。302名患者均未死亡。有25名女性发生心血管事件（心血管事件组），277名女性未发生心血管事件（非心血管事件组）；对两组进行了比较。围产期结局方面未发现显著差异。孕前用药被确定为心血管事件的一个风险因素（调整后的优势比为23.28；95%置信区间为8.15 - 66.47；p<0.001）。在患有心血管疾病的孕妇中，与纽约心脏协会（NYHA）功能分级I级相比，孕前NYHA功能分级II级或III级与心血管事件风险较高相关（两者p均<0.001）。结论 孕前用药和NYHA功能分级>I级是患有心血管疾病的孕妇发生心血管事件的风险因素。
