PŮVODNÍ PRÁCE Adverse obstetric and neonatal outcomes of pregnancy in high-risk women with heart disease | E9 / Vnitř Lék. 2024;70(3):E4-E9 / VNITŘNÍ LÉKAŘSTVÍ www.casopisvnitrnilekarstvi.cz Several risk scores are used to stratify the risk of cardiac complications of pregnancy in women with heart disease. The mWHO, CARPREG, and ZAHARA systems are most often reported in the literature (11-13). Balci et al. prospectively validated cardiovascular and offspring risk models for pregnant women with CHD. They determined the outcomes of 213 pregnancies in 203 women. The ZAHARA I, CARPREG, and mWHO models were evaluated. Offspring events occurred during 77 pregnancies in 81 children (37.3%). All models performed insufficiently in predicting offspring events (AUC [area under the curve] ≤ 0.6) (14). Limitations A limitation of the study is the retrospective design and small sample size. We did not include patients with clinically insignificant heart disease. Therefore, there may be a certain form of selection bias. Risk categorization according to mWHO classes does not allow for accurately classifying all pregnant women with heart disease. That is why we created the mWHO < III class. Since these parturients did not exactly meet the criteria of mWHO classes III or IV, we do not assume that their inclusion in group 1 significantly affected the results. Conclusions Pregnancy in women at high to extremely high maternal risk (mWHO III-IV) was burdened with a high risk of neonatal and obstetric complications. We found significantly worse obstetric and neonatal outcomes in pregnancies in mWHO classes III-IV than in mWHO classes < III. DECLARATIONS: Declaration of originality: The manuscript is original and has not been published or submitted elsewhere. Conflict of interest and financial disclosures: None. Funding/Support: None. REFERENCES 1. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018;39(34):3165–41. 2. Pieper P. Pregnancy risk assessment. In: Camm AJ, Lüscher TF, Maurer G, et al. The ESC Textbook of Cardiovascular Medicine (3 edn). Oxford University Press: Oxford 2018:2851. ISBN 9780198784906. 3. Roos-Hesselink J, Baris L, Johnson M, et al. Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC). Eur Heart J. 2019;40(47):3848-55. 4. Jastrow N, Meyer P, Khairy P, et al. Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center. Int J Cardiol. 2011;151(2):209-13. 5. Toprak B, Govorov K, Kurz K, et al. Outcome of pregnancy in a contemporary cohort of adults with congenital heart disease- a 10-year, single-center experience. Cardiovasc Diagn Ther 2021;11(6):1344-55. 6. Fernández-Campos BA, Vargas-Peñafiel J, Cruz-Dominguez MP, et al. Cardiac and obstetric outcomes in pregnant patients with heart disease: a retrospective cohort study. J Matern Fetal Neonatal Med. 2022;35(25):5140-5148. 7. Suwanrath Ch, Thongphanang P, Pinjaroen S, et al. Validation of modified World Health Organization classification for pregnant women with heart disease in a tertiary care center in southern Thailand. Int J Womens Health. 2018:10:47-53. 8. Roos-Hesselink JW, Ruys TPE, Stein JI, et al. Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. Eur Heart J. 2013;34(9):657-65. 9. Santacesaria S, Cataldo S, Annoni GA, et al. Pregnancy in women with cardiovascular disease in the guidelines era: an Italian single-center experience. J Cardiovasc Med (Hagerstown). 2016;17(10):750-5. 10. van Hagen IM, Roos-Hesselink JW, Donvito V, et al. Incidence and predictors of obstetric and fetal complications in women with structural heart disease. Heart 2017;103(20):1610-18. 11. Siu SC, Sermer M, Colman JM, et al. Cardiac Disease in Pregnancy (CARPREG) Investigators. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104(5):515-21. 12. Drenthen W, Boersma E, Balci A, et al. ZAHARA Investigators. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J. 2010;31(17):2124-32. 13. Kampman MA, Balci A, van Veldhuisen DJ, et al. ZAHARA II investigators. N-terminal pro-B-type natriuretic peptide predicts cardiovascular complications in pregnant women with congenital heart disease. Eur Heart.J 2014;35(11):708-15. 14. Balci A, Sollie-Szarynska KM, van der Bijl AGL, et al. Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease. Heart 2014;100(17):1373-81.
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