Clinical features and peripartum outcomes in pregnant women with cardiac disease: a nationwide retrospective cohort study in Japan
Clinical features and peripartum outcomes in pregnant women with cardiac disease: a nationwide retrospective cohort study in Japan
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DOI：
10.1007/s00380-018-1137-1
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发表时间：
2018-08-01
影响因子：
1.5
通讯作者：
Yasunaga, Hideo
中科院分区：
文献类型：
--
作者：
Isogai, Toshiaki;Matsui, Hiroki;Yasunaga, Hideo
尽管世界范围内心脏病妇女怀孕的数量正在增加，但关于其临床特征和围产期结局的数据很少。使用2008年至2014年日本的诊断程序组合数据库，我们回顾性地确定了因产科或非产科合并症而接受高风险分娩的孕妇。我们将符合条件的妇女分为既存心脏病（心脏病组）和非心脏病合并症（非心脏病组），并比较其特征和围产期结局。在556家医院接受高风险分娩的94 364名妇女中，857名（0.91%）有预先存在的心脏病（302名先天性心脏病; 190名心律失常; 176名瓣膜性心脏病; 120名缺血性心脏病; 65名心肌病; 4名心包疾病）。与非心脏病组相比，心脏病组的女性更有可能在大学医院（51.1%对28.6%; p < 0.001）和重症监护室（33.5%对18.8%; p < 0.001）接受治疗。心脏病组剖宫产率为69.4%（急诊28.4%;择期41.1%），非心脏病组剖宫产率为73.4%（急诊38.4%;择期35.0%）。心脏病组阴道分娩时使用硬膜外镇痛的频率明显高于非心脏病组（15.6%对2.3%; p < 0.001）。心脏病组心力衰竭的发生率高于非心脏病组（10.2%对0.3%; p < 0.001）。在心脏亚组比较中，患有先天性心脏病（12.3%）、瓣膜性心脏病（12.5%）或心肌病（12.3%）的女性比患有心律失常（6.3%）或缺血性心脏病（5.8%）的女性更常发生心力衰竭。多变量logistic回归分析显示，既存心脏病与心力衰竭风险之间存在显著正相关（校正比值比，24.7; 95%置信区间，17.6-34.6; p < 0.001）。心脏病组没有女性死亡，而非心脏病组有18名女性（0.02%）死亡（p = 1.000）。这些发现表明，有心脏病的孕妇在围产期发生心力衰竭的风险高于无心脏病的孕妇。
Although the number of pregnancies in women with cardiac disease is increasing worldwide, there are few data concerning their clinical characteristics and peripartum outcomes. Using the Diagnosis Procedure Combination database between 2008 and 2014 in Japan, we retrospectively identified pregnant women who underwent high-risk delivery due to obstetric or non-obstetric comorbidities. We classified eligible women into those with pre-existing cardiac disease (cardiac disease group) and those with non-cardiac comorbidities (non-cardiac disease group) and compared their characteristics and peripartum outcomes. Of 94,364 women undergoing high-risk delivery at 556 hospitals, 857 (0.91%) had pre-existing cardiac disease (302, congenital heart disease; 190, arrhythmia; 176, valvular heart disease; 120, ischemic heart disease; 65, cardiomyopathy; 4, pericardial disease). Women in the cardiac disease group were more likely to be treated at university hospitals (51.1 versus 28.6%; p < 0.001) and in intensive care units (33.5 versus 18.8%; p < 0.001) than those in the non-cardiac disease group. The proportion of cesarean deliveries was 69.4% (emergency, 28.4%; elective, 41.1%) in the cardiac disease group and 73.4% (emergency, 38.4%; elective, 35.0%) in the non-cardiac disease group. Epidural analgesia during vaginal delivery was used significantly more frequently in the cardiac disease than non-cardiac disease group (15.6 versus 2.3%; p < 0.001). Heart failure occurred more frequently in the cardiac disease than the non-cardiac disease group (10.2 versus 0.3%; p < 0.001). In cardiac subgroup comparisons, heart failure occurred more frequently in women with congenital heart disease (12.3%), valvular heart disease (12.5%), or cardiomyopathy (12.3%) than in women with arrhythmia (6.3%) or ischemic heart disease (5.8%). Multivariable logistic regression analysis showed a significant positive association between pre-existing cardiac disease and risk of heart failure (adjusted odds ratio, 24.7; 95% confidence interval, 17.6-34.6; p < 0.001). No woman in the cardiac disease group died, whereas 18 women (0.02%) in the non-cardiac disease group did (p = 1.000). These findings suggest that pregnant women with pre-existing cardiac disease are at a higher risk of heart failure during the peripartum period than those with non-cardiac comorbidities.