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Background <p>Cardiac disease in pregnancy presents complex clinical challenges and remains a leading cause of non-obstetric maternal mortality worldwide. Most available data on the prevalence and outcomes of heart disease in pregnancy come from high-income Western countries, limiting their applicability to low- and middle-income countries (LMICs). This study, conducted at a tertiary perinatal center in an LMIC setting, aims to describe the spectrum of cardiovascular disease in pregnancy and to evaluate maternal and perinatal outcomes, contributing context-specific evidence to the evolving field of cardio-obstetrics.</p> Methods <p>We conducted a retrospective cohort study of pregnant women with pre-existing cardiac disease or heart disease first diagnosed during pregnancy, managed at our institute over an eleven-year period (January 2013 to December 2023). Major adverse cardiac events (MACE), along with obstetric and neonatal outcomes, were recorded. Receiver operating characteristic (ROC) analysis was performed to assess the predictive accuracy of Modified World Health Organization (mWHO) classification and CARPREG-II scores for MACE.</p> Results <p>The cohort included 606 pregnancies in 521 women. Congenital heart disease was the most common diagnosis (41.1%), followed by valvular heart disease (32.8%) and arrhythmias (21.3%). Nearly one-quarter of women were diagnosed with cardiac disease during pregnancy. MACE occurred in 6.6% of pregnancies. mWHO classification demonstrated satisfactory discrimination for predicting MACE(AUC 0.73), while CARPREG-II showed modest predictive ability(AUC 0.66).</p> Conclusion <p>Risk prediction tools developed in Western populations may not perform uniformly across diverse settings. Changing patterns of cardiac disease in pregnancy highlight the need for risk models that better reflect contemporary and region-specific cardiovascular profiles.</p>

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Maternal and Perinatal Outcomes in Pregnancies Complicated by Heart Disease: A Decade of Experience at a Tertiary Center and Validation of Contemporary Risk Stratification Systems

  • 期刊论文

  • 发表日期：

    2026年7月20日

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  • Malini Sukayogula,
  • Tarakeswari Surapaneni,
  • Anisha Gala Shah,
  • Ananta Ghimire

摘要

Background

Cardiac disease in pregnancy presents complex clinical challenges and remains a leading cause of non-obstetric maternal mortality worldwide. Most available data on the prevalence and outcomes of heart disease in pregnancy come from high-income Western countries, limiting their applicability to low- and middle-income countries (LMICs). This study, conducted at a tertiary perinatal center in an LMIC setting, aims to describe the spectrum of cardiovascular disease in pregnancy and to evaluate maternal and perinatal outcomes, contributing context-specific evidence to the evolving field of cardio-obstetrics.

Methods

We conducted a retrospective cohort study of pregnant women with pre-existing cardiac disease or heart disease first diagnosed during pregnancy, managed at our institute over an eleven-year period (January 2013 to December 2023). Major adverse cardiac events (MACE), along with obstetric and neonatal outcomes, were recorded. Receiver operating characteristic (ROC) analysis was performed to assess the predictive accuracy of Modified World Health Organization (mWHO) classification and CARPREG-II scores for MACE.

Results

The cohort included 606 pregnancies in 521 women. Congenital heart disease was the most common diagnosis (41.1%), followed by valvular heart disease (32.8%) and arrhythmias (21.3%). Nearly one-quarter of women were diagnosed with cardiac disease during pregnancy. MACE occurred in 6.6% of pregnancies. mWHO classification demonstrated satisfactory discrimination for predicting MACE(AUC 0.73), while CARPREG-II showed modest predictive ability(AUC 0.66).

Conclusion

Risk prediction tools developed in Western populations may not perform uniformly across diverse settings. Changing patterns of cardiac disease in pregnancy highlight the need for risk models that better reflect contemporary and region-specific cardiovascular profiles.