Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada.
ICES Western, London, Canada.
Am J Obstet Gynecol MFM. 2020 Aug;2(3):100105. doi: 10.1016/j.ajogmf.2020.100105. Epub 2020 Mar 23.
Women with a prosthetic heart valve are perceived to be at higher risk for adverse outcomes, but their absolute and relative risk of experiencing maternal morbidity and cardiac complications is largely unknown.
The objective of the study was to determine the risk of maternal morbidity and cardiac complications in women with a prior heart valve replacement, compared with matched counterparts without known cardiac disease.
A retrospective population-based matched cohort study was completed in the province of Ontario, Canada, where there is universal health care. Included were all women of child-bearing age who had bioprosthetic or mechanical replacement of the mitral or aortic valve, April 1994 to March 2016 (valve replacement group). Those in the valve replacement group, and who had at least 1 birth, were 1:4 matched to a community comparison group without heart disease and who also had at least 1 birth. Matching was by maternal age at cohort entry, year of cohort entry, geographic area, income level, and age at first birth. Maternal outcomes included severe maternal morbidity, all-cause mortality, and cardiac morbidity as well as a prolonged hospital length of stay >7 days. Relative risks and 95% confidence intervals were further adjusted for age at birth and immigration status.
There were 90 live births among the 64 women in the valve replacement group and 404 live births among the 253 women in the matched community comparison group. There were no stillbirths. Severe maternal morbidity occurred in 13 pregnancies (14.4%) in the valve replacement group and 6 (1.5%) in the community comparison group (adjusted relative risk, 9.73, 95% confidence interval, 3.70-25.59); there were no maternal deaths. The corresponding rates of prolonged hospital length of stay were 37.8% and 18.8% (adjusted relative risk, 2.33, 95% confidence interval, 1.48-3.67).
Pregnant women who had aortic or mitral valve replacement were more likely to experience severe maternal morbidity, as well as prolonged hospital length of stay, than matched counterparts without heart disease. This information can enhance shared decision making about the timing of valve replacement and pregnancy planning in young and middle-aged women. To determine the absolute and relative risk of maternal morbidity and cardiac complications in women with prior heart valve replacement, a retrospective population-based matched cohort study was completed in the province of Ontario, Canada, where there is universal health care. Included were all women of child-bearing age who had bioprosthetic or mechanical replacement of the mitral or aortic valve, April 1994 to March 2016 (valve replacement group). Those in the valve replacement group, and who had at least one birth, were 1:4 matched to a community comparison group without heart disease and who also had at least 1 birth. There were 90 live births among the 64 women in the valve replacement group and 404 live births among the 253 women in the matched community comparison group. Severe maternal morbidity occurred in 13 pregnancies (14.4%) in the valve replacement group and 6 (1.5%) in the community comparison group (adjusted relative risk, 9.73); there were no maternal deaths. The corresponding rates of prolonged hospital length of stay were 37.8% and 18.8% (adjusted relative risk, 2.33). In summary, pregnant women who had an aortic or mitral valve replacement were more likely to experience severe maternal morbidity, as well as prolonged hospital length of stay, than matched counterparts without heart disease.
人们认为患有人工心脏瓣膜的女性发生不良后果的风险更高，但她们发生孕产妇发病率和心脏并发症的绝对风险和相对风险在很大程度上尚不清楚。
本研究的目的是确定与没有已知心脏病的匹配对照组相比，先前接受过二尖瓣或主动脉瓣置换术的女性发生孕产妇发病率和心脏并发症的风险。
这是一项在加拿大安大略省完成的回顾性基于人群的匹配队列研究，该省实行全民医疗保健。研究对象包括所有在 1994 年 4 月至 2016 年 3 月期间接受生物瓣或机械瓣置换二尖瓣或主动脉瓣的育龄妇女（瓣膜置换组）。瓣膜置换组中至少生育过 1 次的患者与没有心脏病且至少生育过 1 次的社区对照组以 1:4 的比例进行匹配。匹配因素包括产妇入组时的年龄、入组年份、地理区域、收入水平和首次分娩年龄。产妇结局包括严重孕产妇发病率、全因死亡率和心脏发病率以及住院时间延长 >7 天。相对风险和 95%置信区间进一步根据出生时的年龄和移民状况进行调整。
在瓣膜置换组的 64 名女性中，有 90 名活产，在匹配的社区对照组的 253 名女性中，有 404 名活产。没有死产。瓣膜置换组中有 13 例（14.4%）妊娠发生严重孕产妇发病率，而社区对照组中有 6 例（1.5%）（调整后的相对风险，9.73；95%置信区间，3.70-25.59）；没有孕产妇死亡。相应的延长住院时间比例分别为 37.8%和 18.8%（调整后的相对风险，2.33；95%置信区间，1.48-3.67）。
与没有心脏病的匹配对照组相比，接受过主动脉瓣或二尖瓣置换术的孕妇发生严重孕产妇发病率和延长住院时间的可能性更高。这些信息可以增强年轻和中年女性在瓣膜置换和妊娠计划时间方面的共同决策。为了确定有先前心脏瓣膜置换史的女性发生孕产妇发病率和心脏并发症的绝对和相对风险，在加拿大安大略省完成了一项回顾性基于人群的匹配队列研究，该省实行全民医疗保健。研究对象包括所有在 1994 年 4 月至 2016 年 3 月期间接受生物瓣或机械瓣置换二尖瓣或主动脉瓣的育龄妇女（瓣膜置换组）。瓣膜置换组中至少生育过 1 次的患者与没有心脏病且至少生育过 1 次的社区对照组以 1:4 的比例进行匹配。在瓣膜置换组的 64 名女性中，有 90 名活产，在匹配的社区对照组的 253 名女性中，有 404 名活产。瓣膜置换组中有 13 例（14.4%）妊娠发生严重孕产妇发病率，而社区对照组中有 6 例（1.5%）（调整后的相对风险，9.73）；没有孕产妇死亡。相应的延长住院时间比例分别为 37.8%和 18.8%（调整后的相对风险，2.33）。总之，与没有心脏病的匹配对照组相比，患有主动脉瓣或二尖瓣置换术的孕妇发生严重孕产妇发病率和延长住院时间的可能性更高。
