Pregnant Women With Heart Disease in Southwestern China

Real-world In-hospital Outcomes and Potential Predictors of Heart Failure in Pregnant Women With Heart Disease in Southwestern China

Little is known about the status of maternal, obstetric and neonatal complications and the potential predictors of developing heart failure (HF) in the mothers with underlying heart disease (HD) in Southwestern China. Eligible samples were screened from December, 2010 to December, 2019. Maternal clinical characteristics and in-hospital outcomes were collected and compared in women with and without HD, and in HD subtypes: valvular heart disease (VHD), cardiomyopathy, adult congenital heart disease (ACHD), pulmonary hypertension (PH) and other cardiac condition.

Study Overview

• Status: Completed
• Conditions: Complications of Heart Disease (HD)

Detailed Description

Data Source and Study Population We enrolled patients from seven main medical centers in Southwestern China,that was used to characterize outcomes from December 1, 2010 to December 31, 2019. All pregnant women (excluding abortion, nonfirst delivery, multiple births) were eligible for inclusion in the present analysis. Cardiac disease of pregnant woman in the analysis mainly included valvular heart disease (VHD), cardiomyopathy, adult congenital heart disease (ACHD), pulmonary hypertension (PH) and other cardiac conditions (primary arrythmia, coronary heart disease, anemic heart disease, hyperthyroid heart disease and others). Only singleton records with a unique medical identified number were used in our analysis. Patients aged <18 years and those with missing information including unique patient identifiers were excluded. Records with the same date of birth, admission date, discharge date, and facility name were considered as pure duplications, and only one of such records was kept. The data set was analyzed retrospectively, and the informed consent requirement was waived.

Outcome Measures Hypertensive disorders of pregnancy were defined and classified mainly as the following two types from ISSHP (International Society for the Study of Hypertension in Pregnancy) Classification, Diagnosis, and Management Recommendations for International Practice: Hypertension known before pregnancy or present in the first 20 weeks; Hypertension arising de novo at or after 20 weeks.[10] Maternal major adverse cardiac events (MACE) were defined as a composite of arrhythmia, shock, cerebrovascular events, heart failure, respiratory failure, in-hospital death, pulmonary embolism, dissection of any artery.[3, 11, 12] Cardiac procedural intervention was also recorded for patients with and without HD. Non-MACE maternal outcomes included acute renal failure, total hospital charges and hypertensive disorders of pregnancy (all types). Obstetric complications mainly included adherent placenta, abruptio placenta, breech delivery, DIC (disseminated intravascular coagulation), early or threatened labor, known or suspected fetal abnormality, laceration, long labor, placental insufficiency, placenta previa, precipitate labor, premature rupture of membranes, polyhydramnios, postpartum hemorrhage and infection. Neonatal adverse clinical events (NACE) were a composite of fetal death (in utero), neonate death (within 30 days of birth), prematurity (<37 weeks), intrauterine growth restriction, respiratory distress syndrome and intracranial cerebral events. NON-MACE variables including infant of low-birth weight (weight<2500g) and fetal macrosomia (weight>4000g) were also measured. HF was defined in these patients with various underlying heart diseases as a clinical syndrome that was characterized by specific symptoms (dyspnea and fatigue) and signs (of fluid retention, such as edema, rales) as judged by the treating cardiologist according to ACC/AHA guidelines.[13] Information for the present analysis was obtained through review of the institutional database, into which data had been entered on discharge of each patient.

• Study Type: Observational
• Enrollment (Actual): 508

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

. All primigravid women (excluding abortion, multiparous women, and multiple births) were eligible for inclusion in the present analysis. The cardiac diseases of a pregnant woman in the analysis included VHD, cardiomyopathy, ACHD, PH, and other cardiac conditions (primary arrythmia, coronary HD, anemic HD, and hyperthyroid HD)

Description

Inclusion Criteria:

• All pregnant women (excluding abortion, nonfirst delivery, multiple births) were eligible for inclusion in the present analysis. Cardiac disease of pregnant woman in the analysis mainly included valvular heart disease (VHD), cardiomyopathy, adult congenital heart disease (ACHD), pulmonary hypertension (PH) and other cardiac conditions (primary arrythmia, coronary heart disease, anemic heart disease, hyperthyroid heart disease and others). Only singleton records with a unique medical identified number were used in our analysis. Records with the same date of birth, admission date, discharge date, and facility name were considered as pure duplications, and only one of such records was kept.

Exclusion Criteria:

• abortion, nonfirst delivery, multiple births Patients aged <18 years and those with missing information including unique patient identifiers were excluded.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
maternal, obstetric, and neonatal complications	major adverse cardiac events (MACEs), obstetric complications and neonatal adverse clinical events (NACEs)	2010-2019

Collaborators and Investigators

• Sponsor: First Affiliated Hospital of Chongqing Medical University

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2010
• Primary Completion (Actual): December 1, 2019
• Study Completion (Actual): December 1, 2019

Study Registration Dates

• First Submitted: December 1, 2021
• First Submitted That Met QC Criteria: December 1, 2021
• First Posted (Actual): December 3, 2021

Study Record Updates

• Last Update Posted (Actual): December 3, 2021
• Last Update Submitted That Met QC Criteria: December 1, 2021
• Last Verified: December 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases
• Other Study ID Numbers: 2019XMSB0001234

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No