Predictors of maternal and neonatal complications in women with severe valvular heart disease during pregnancy in Tunisia: a retrospective cohort study.

Background: Severe valvular heart disease, especially stenosis, is a contraindication for conception according to the World Health Organization. This is still encountered in countries with a high rheumatic fever prevalence. The objective of this study was to determine predictors of maternal cardiac, obstetric and neonatal complications in pregnant women with severe valve disease.

Methods: This is an observational retrospective cohort study of all pregnant women with severe heart valvulopathy who gave birth between 2010 and 2017.

Results: We included 60 pregnancies in 54 women. Cardiac complications occurred during 37 pregnancies (61%). In multivariate analysis, parity (aOR =2.41, 95% CI[1.12-5.16]), revelation of valvulopathy during pregnancy (aOR = 6.34; 95% CI[1.26-31.77]), severe mitral stenosis (aOR = 6.98, 95% CI[1.14-41.05],) and systolic pulmonary arterial pressure (aOR =1.08, 95% CI[1.01-1.14]) were associated with cardiac complications. Obstetrical complications were noted during 19 pregnancies (31.8%). These complications were associated with nulliparity (aOR = 5.22; 95% CI[1.15-23.6]), multiple valve disease (aOR = 5.26, 95% CI[1.19-23.2]), systolic pulmonary arterial pressure (aOR =1.04, 95% CI[1.002-1.09]), and treatment with vitamin K antagonists (aOR = 8.71, 95% CI[1.98-38.2]). Neonatal complications were noted in 39.3% of newborns (n = 61) and these were associated with occurrence of obstetric complications (aOR = 16.47, 95% CI[3.2-84.3]) and revelation of valvulopathy during pregnancy (aOR = 7.33, 95% CI[1.4-36.1]).

Conclusions: Revelation of valvular heart disease during pregnancy is a predictor of not only cardiac but also neonatal complications. Valvular heart disease screening during pre-conceptional counseling is thus crucial.