Pregnant women with underlying cardiovascular disease may have better maternal outcomes and lower post-delivery readmissions if they are managed by a cardio-obstetrics team, according to a study published Oct. 26 in the Journal of the American College of Cardiology.

Ella Magun, MD, et al., describe clinical characteristics, cardiovascular readmissions, and maternal and fetal outcomes in a cohort of 306 pregnant women with underlying cardiovascular disease who were followed by a cardio-obstetrics team between January 2010 and December 2019. The median age was 29 years, 52% were Hispanic or Latino, and 74.2% were Medicaid beneficiaries.

Among the 302 patients included the readmission analysis, primary outcome results showed six (1.9%) were readmitted within 30 days – five for symptomatic heart failure and one for blood pressure management. Excluding those readmitted within 30 days, there were 14 readmissions (4.6%) within 90 days, most commonly for heart failure. After one year, 17 patients (6.5%) were readmitted.

Life births occurred in 300 pregnancies (98%). Of these, 150 underwent a cesarean section and 150 gave birth vaginally. In addition, 140 women (46.5%) were induced. Secondary outcome results showed there was one pregnancy-related death in a patient with Eisenmenger syndrome. During the follow-up period, three patients had an LVAD implantation and two had a heart transplant. Fetal demise, defined as stillbirth >20 weeks, occurred in four pregnancies.

According to the researchers, the findings suggest that cardio-obstetrics programs "may help provide improved cardiovascular care to an otherwise underserved population," noting that maternal outcomes were "encouraging," and readmission rates were low. Moving forward, additional research is needed to evaluate the impact of cardio-obstetrics care models on maternal outcomes, they conclude.

In an accompanying editorial comment, Pamela Ouyang, MBBS, FACC, and Garima Sharma, MD, FACC, note that up to 68% of pregnancy-related deaths are caused by cardiovascular and coronary conditions, concluding that cardio-obstetrics programs "have the promise to reduce maternal mortality and address the existing disparities in this country."

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Heart Transplant, Interventions and Structural Heart Disease

Keywords: Maternal Mortality, Cesarean Section, Stillbirth, Obstetrics, Eisenmenger Complex, Blood Pressure, Medicaid, Cardiovascular Diseases, Follow-Up Studies, Fetal Death, Heart Failure, Heart Transplantation, Prenatal Care

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