Predictive factors for adverse pregnancy outcomes in women with rheumatic valvular heart disease: A single-center retrospective analysis

Abstract

Objective: To analyze maternal and perinatal outcomes in women with rheumatic valvular heart disease and to evaluate the predictive factors for adverse cardiac outcomes in this cohort. Methods: A retrospective analysis was performed of pregnant women with rheumatic heart disease (RHD) who delivered at a tertiary care referral hospital over a 5-year period from 2018 to 2023. Results: A total of 118 pregnant women with RHD were encountered during the study period. The mitral valve was most commonly affected (75/118; 62.7%), 79/118 (66.9%) underwent cardiac interventions, and 39/118 (33%) were on anticoagulation medication. Deterioration in New York Heart Association (NYHA) functional class was noted in 36/118 (30.5%) of these women prenatally, and cardiac failure developed in 18/118 (15.3%). New-onset arrhythmia occurred in 6/118 (5.1%), which was managed medically. Mean gestational age at delivery was 36.73 ± 2.53 weeks, with a cesarean delivery rate of 68/118 (57.6%). Among fetal and neonatal outcomes, average birth weight was 2390.46 ± 574.46 g, with 38/118 (32.2%) being preterm and 61/118 (52.5%) being low birth weight. Key predictors of poor cardiac outcomes included more than one affected valve and a poor NYHA functional class (more than II) at admission. Patients with mechanical heart valves faced higher risks from anticoagulation. Conclusion: Pregnancy in women with RHD is associated with adverse maternal cardiac, obstetrical, and neonatal outcomes. More than one affected heart valve and a poor NYHA functional class were found to be strong predictors of adverse cardiac outcomes during pregnancy. A specialized cardio-obstetric team is crucial for enhancing pregnancy outcomes.