Cardiovascular outcomes of pregnancy in Turner syndrome

ObjectivesWomen with Turner syndrome (TS) are frequently counselled against pregnancy due to lack of data and unclear aortic dissection risk. However, with advances in fertility therapy, more women with TS are contemplating pregnancy. This study compared rates of adverse cardiovascular (CV) outcomes among: (1) pregnant and non-pregnant women with TS and (2) pregnant women with TS with/without structural heart disease.MethodsRetrospective analysis of pregnant and age-matched non-pregnant controls with TS (2005–2017) across 10 CV centres was done. Data were collected at initial evaluation in pregnancy and outcomes were assessed to 6 months postpartum. Adverse CV events were defined as CV death, aortic dissection/rupture and/or aortic intervention. Non-pregnant age-matched controls were followed over the same time period.ResultsSixty-eight pregnancies were included (60 women, mean age 33 years, 48% primigravid, 49% fertility therapy, 80% structurally normal heart, 25% XO karyotype). Based on American Society of Reproductive Medicine criteria, 10 pregnancies occurred in women stratified to high-risk category. There were no CV events in the pregnant women or in the non-pregnant women with TS. Obstetric events complicated 12 (18%) pregnancies with 9 (13%) attributed to hypertensive disorder of pregnancy. Fetal events included small for gestational age neonates (18%), preterm delivery (15%) and fetal death (3%).ConclusionsThis study helps to refine the approach to pregnancy in women with TS. Among women with TS without structural heart disease, pregnancy does not impose an increased risk of CV outcomes. Among women with TS with structural heart disease, the risk of pregnancy is not as prohibitive as previously described but does require ongoing evaluation.

Download Full-text

Use of Routine Echocardiographic Screening for Structural Heart Disease in At-Risk Pregnant Women in India

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2020.08.032 ◽

2020 ◽

Author(s):

Amisha Patel ◽

Lauren S. Ranard ◽

Nicole Aranoff ◽

Hussein Rahim ◽

Roja Vanukuru ◽

...

Keyword(s):

At Risk ◽

Heart Disease ◽

Pregnant Women ◽

Structural Heart Disease ◽

Women In India

Download Full-text

Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study

Viruses ◽

10.3390/v13050853 ◽

2021 ◽

Vol 13 (5) ◽

pp. 853

Author(s):

Sara Cruz Melguizo ◽

María Luisa de la Cruz Conty ◽

Paola Carmona Payán ◽

Alejandra Abascal-Saiz ◽

Pilar Pintando Recarte ◽

...

Keyword(s):

Pregnant Women ◽

Perinatal Outcomes ◽

Preterm Births ◽

Hypertensive Disorder ◽

Obstetric Emergency ◽

Increased Risk ◽

Emergency Group ◽

Adverse Perinatal Outcomes ◽

Maternal Disease ◽

The Relationship

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients’ information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

Download Full-text

Antithrombotic Therapy in Patients Undergoing Transcatheter Interventions for Structural Heart Disease

Circulation ◽

10.1161/circulationaha.121.054305 ◽

2021 ◽

Vol 144 (16) ◽

pp. 1323-1343

Author(s):

Paolo Calabrò ◽

Felice Gragnano ◽

Giampaolo Niccoli ◽

Rossella Marcucci ◽

Marco Zimarino ◽

...

Keyword(s):

Heart Disease ◽

Antithrombotic Therapy ◽

Structural Heart Disease ◽

Current Evidence ◽

Bleeding Complications ◽

Tricuspid Valve Repair ◽

Left Atrial Appendage Occlusion ◽

Increased Risk ◽

Valve Implantation ◽

Transcatheter Interventions

Contemporary evidence supports device-based transcatheter interventions for the management of patients with structural heart disease. These procedures, which include aortic valve implantation, mitral or tricuspid valve repair/implantation, left atrial appendage occlusion, and patent foramen ovale closure, profoundly differ with respect to clinical indications and procedural aspects. Yet, patients undergoing transcatheter cardiac interventions require antithrombotic therapy before, during, or after the procedure to prevent thromboembolic events. However, these therapies are associated with an increased risk of bleeding complications. To date, challenges and controversies exist regarding balancing the risk of thrombotic and bleeding complications in these patients such that the optimal antithrombotic regimens to adopt in each specific procedure is still unclear. In this review, we summarize current evidence on antithrombotic therapies for device-based transcatheter interventions targeting structural heart disease and emphasize the importance of a tailored approach in these patients.

Download Full-text

Effectiveness of Implanted Cardiac Rhythm Recorders With Electrocardiographic Monitoring for Detecting Arrhythmias in Pregnant Women With Symptomatic Arrhythmia and/or Structural Heart Disease

JAMA Cardiology ◽

10.1001/jamacardio.2019.5963 ◽

2020 ◽

Vol 5 (4) ◽

pp. 458 ◽

Cited By ~ 4

Author(s):

Karen Sliwa ◽

Feriel Azibani ◽

Mark R. Johnson ◽

Charle Viljoen ◽

Johann Baard ◽

...

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Cardiac Rhythm ◽

Structural Heart Disease ◽

Electrocardiographic Monitoring

Download Full-text

Effects of seasonal and climate variations on in-hospital mortality and length of stay in patients with type A aortic dissection

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01639-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zeng-Rong Luo ◽

Zhi-Qin Lin ◽

Liang-wan Chen ◽

Han-Fan Qiu

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Length Of Stay ◽

Aortic Dissection ◽

Hospital Mortality ◽

Type A ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Medical Quality ◽

Increased Risk

Abstract Objective To investigate the effects of seasonal and climatic changes on postoperative in-hospital mortality and length of stay (LOS) in patients with type A acute aortic dissection (AAD). Methods Patients undergoing implantation of the modified triple-branched stent graft to replace the descending aorta in addition to aortic root reconstruction for type A AAD in our hospital from January 2016 to December 2019 were included. Relevant data were retrospectively collected and analyzed. Results A total of 404 patients were included in our analyses. The multivariate unconditional logistic regression analysis showed that patients admitted in autumn (OR 4.027, 95% CI 1.023–17.301, P = 0.039) or with coronary heart disease (OR 8.938, 95% CI 1.991–29.560, P = 0.049) were independently associated with an increased risk of postoperative in-hospital mortality. Furthermore, patients admitted in autumn (OR 5.956, 95% CI 2.719–7.921, P = 0.041) or with hypertension (OR 3.486, 95% CI 1.192–5.106, P = 0.035) were independently associated with an increased risk of longer LOS. Conclusion Patients admitted in autumn or with coronary heart disease are at higher risk of in-hospital mortality following surgery for type A AAD. Also, patients admitted in autumn or with hypertension have a longer hospital LOS. In the autumn of the temperature transition, we may need to strengthen the management of medical quality after surgery for type A AAD.

Download Full-text

LEVEL OF STRESS AMONG PREGNANT WOMEN WITH HEART PROBLEMS

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v4.i7.2016.2614 ◽

2016 ◽

Vol 4 (7) ◽

pp. 220-230

Author(s):

HananElzeblawy Hassan ◽

Eman Ali Abd MoatySheha ◽

ElsaydaHamdy Nasr

Keyword(s):

Heart Disease ◽

Pregnant Women ◽

Urban Areas ◽

First Trimester ◽

Age Group ◽

Obese Women ◽

Substantial Evidence ◽

Medical Disorders ◽

Increased Risk ◽

Depth Interviews

Although its prevalence is comparatively low in pregnant women, heart disease is the most significant cause of maternal mortality. About 2% of pregnancies involve maternal cardiovascular disease and this poses an increased risk to both mother and fetus. In-depth interviews for the convenience of 178 pregnant women with heart disease going through 400 pregnancies associated with medical disorders, which were booked in the high-risk obstetric departments and the antenatal outpatient clinics at all governmental hospitals in Beni-Surf City. The prevalence of heart disease of Pregnancy was 44.5%. The severity level of stress was found in the age group of 25-30 years, obese women, urban areas and women who were in their first trimester, Multigravida and who had a history still birth/birth defects. Statistically significant correlation was found between stress levels and age, education, occupation, income, obesity and residence. There is substantial evidence that heart disease with pregnancy is risk factors for adverse stress outcomes for mothers. More specifically, heart disease with pregnancy is associated with severe level of stress.

Download Full-text

Perinatal outcome in hypertensive disorder of pregnancy in a rural community of Haryana

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20194478 ◽

2019 ◽

Vol 6 (10) ◽

pp. 4267

Author(s):

Bharti . ◽

Sumit Chawla

Keyword(s):

Birth Weight ◽

Pregnant Women ◽

Perinatal Outcome ◽

Statistical Tests ◽

Mode Of Delivery ◽

Hypertensive Disorder ◽

Hypertension In Pregnancy ◽

Hypertensive Disorders ◽

Increased Risk ◽

In Pregnancy

Background: Pregnancy in hypertension may complicate pregnancies with variable incidence among different settings. Pregnancies complicated with hypertensive disorders are associated with increased risk of adverse fetal, neonatal and maternal outcome including preterm birth, intrauterine growth retardation (IUGR), perinatal death etc. The present study was undertaken to study the perinatal outcome of hypertension in pregnancy in a rural block of Haryana.Methods: This cross-sectional study was carried out in the all the 20 subcenters under Community Health Center (CHC) Chiri, Block Lakhanmajra. All the pregnant women registered at the particular subcenter at a point of time of visit were included in the study. Pregnancy outcome was followed-up by contacting the health worker of respective sub-center or mother. Information regarding stillbirth, abortion, maturity, birth weight, mode of delivery and early neonatal death was collected. Appropriate statistical tests were used for analysis.Results: A total of 931 pregnant women were included in the present study. Prevalence of hypertension in pregnancy was found to be 6.9%. Hypertension in pregnancy is significantly associated with premature births still births (6.7% vs 1.4%; p=0.003), low birth weight (26.7% vs 4.9%; p=0.000) and early neonatal deaths (8.3% vs 2.8%; p=0.017).Conclusions: Perinatal mortality is significantly high in mothers with hypertensive disorders. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent hypertensive disorders of pregnancy and its complications.

Download Full-text

Metabolic abnormalities and obesity’s impact on the risk for developing preeclampsia

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00440.2016 ◽

2017 ◽

Vol 312 (1) ◽

pp. R5-R12 ◽

Cited By ~ 26

Author(s):

Frank T. Spradley

Keyword(s):

Pregnant Women ◽

Vascular Dysfunction ◽

Hypertensive Disorder ◽

Metabolic Abnormalities ◽

Obese Women ◽

Maternal Circulation ◽

Increased Risk ◽

Tnf Α ◽

Hypertensive Disorder Of Pregnancy ◽

Factor Α

Preeclampsia (PE), a hypertensive disorder of pregnancy, is increasing as a major contributor to perinatal and long-term morbidity of mother and offspring. PE is thought to originate from ischemic insults in the placenta driving the release of prohypertensive anti-angiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1)] and proinflammatory [tumor necrosis factor-α (TNF-α)] factors into the maternal circulation. Whereas the increased incidence of PE is hypothesized to be largely due to the obesity pandemic, the mechanisms whereby obesity increases this risk are unknown. The maternal endothelium is targeted by placental and adipose tissue-derived factors like sFlt-1 and TNF-α that promote hypertension during pregnancy, resulting in vascular dysfunction and hypertension. Interestingly, not all obese pregnant women develop PE. Data suggest that obese pregnant women with the greatest metabolic abnormalities have the highest incidence of PE. Identifying obesity-related mechanisms driving hypertension in some obese pregnant women and pathways that protect normotensive obese pregnant women, may uncover novel protocols to treat PE. Metabolic abnormalities, such as increased circulating leptin, glucose, insulin, and lipids, are likely to increase the risk for PE in obese women. It is not only important to understand whether each of these metabolic factors contribute to the increased risk for PE in obesity, but also their cumulative effects. This is particularly relevant to obese pregnant women with gestational diabetes mellitus (GDM) where all of these factors are increased and the risk for PE is highest. It is speculated that these factors potentiate the anti-angiogenic and proinflammatory mechanisms of placental ischemia-induced vascular dysfunction thereby contributing to the increasing incidence of PE.

Download Full-text