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Prevalence of pre-eclampsia and adverse pregnancy outcomes in women with pre-existing cardiomyopathy: a multi-centre retrospective cohort study.
  • +29
  • Laura Ormesher,
  • Sarah Vause,
  • Suzanne Higson,
  • Anna Roberts,
  • Bernard Clarke,
  • Steph Curtis,
  • Victoria Ordonez,
  • Faiza Ansari,
  • Thomas Everett,
  • Claire Hordern,
  • Lucy Mackillop,
  • Victoria Stern,
  • Tessa Bonnett,
  • Alice Reid,
  • Suzanne Wallace,
  • Ebruba Ese,
  • Hannah Douglas,
  • M. Cauldwell,
  • Maya Reddy,
  • Kirsten Palmer,
  • Maggie Simpson,
  • Janet Brennand,
  • Laura Minns,
  • Leisa Freeman,
  • Sarah Murray,
  • Nirmala Mary,
  • James Castleman,
  • Katie Morris,
  • Elizabeth Haslett,
  • Christopher Cassidy,
  • Edward Johnstone,
  • Jenny Myers
Laura Ormesher
The University of Manchester

Corresponding Author:[email protected]

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Sarah Vause
Manchester University NHS Foundation Trust
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Suzanne Higson
Manchester University NHS Foundation Trust
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Anna Roberts
Manchester University NHS Foundation Trust
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Bernard Clarke
Manchester University NHS Foundation Trust
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Steph Curtis
Bristol Royal Infirmary
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Victoria Ordonez
Bristol Royal Infirmary
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Faiza Ansari
Leeds Teaching Hospitals NHS Trust
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Thomas Everett
Leeds Teaching Hospitals NHS Trust
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Claire Hordern
Oxford University Hospitals NHS Foundation Trust
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Lucy Mackillop
Oxford University Hospitals NHS Foundation Trust
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Victoria Stern
The University of Sheffield
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Tessa Bonnett
The University of Sheffield
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Alice Reid
Nottingham University Hospitals NHS Trust
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Suzanne Wallace
Nottingham University Hospitals NHS Trust
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Ebruba Ese
Guy's and St Thomas' NHS Foundation Trust
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Hannah Douglas
Guy's and St Thomas' Hospitals NHS Trust
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M. Cauldwell
St George's University Hospitals NHS Foundation Trust
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Maya Reddy
Monash Health
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Kirsten Palmer
Monash Health
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Maggie Simpson
Golden Jubilee National Hospital West of Scotland Regional Heart and Lung Centre
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Janet Brennand
Queen Elizabeth University Hospital
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Laura Minns
Norfolk and Norwich University Hospital NHS Trust
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Leisa Freeman
Norfolk and Norwich University Hospital NHS Trust
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Sarah Murray
NHS Lothian University Hospitals Division
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Nirmala Mary
NHS Lothian University Hospitals Division
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James Castleman
Birmingham Women's and Children's NHS Foundation Trust
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Katie Morris
University of Birmingham
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Elizabeth Haslett
Blackpool Teaching Hospitals NHS Foundation Trust
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Christopher Cassidy
Blackpool Teaching Hospitals NHS Foundation Trust
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Edward Johnstone
The University of Manchester
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Jenny Myers
The University of Manchester
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Abstract

Objective: To determine the prevalence of pre-eclampsia and fetal growth restriction (FGR; <3rd centile) in women with pre-existing cardiac dysfunction. Design: Retrospective cohort study. Setting: Maternity units in UK and Australia. Population: Pregnant women with impaired left ventricular ejection fraction<55%. Methods: Routine clinical data, including medical history and pregnancy outcome were collected retrospectively. Main Outcome Measures: Pre-specified outcomes included pre-eclampsia and FGR prevalence in women with pre-existing cardiac impairment, compared with the general population; and the relationship between pregnancy outcome and pre-pregnancy cardiac phenotype. Results: In this cohort of 282 pregnancies, pre-eclampsia prevalence was not significantly increased (4.6% [95% C.I 2.2-7.0%] versus population prevalence of 4.6% [95% C.I. 2.7-8.2], p=0.99); 12/13 of these women had additional obstetric/medical risk factors. However, prevalences of preterm pre-eclampsia (<37 weeks) and FGR were increased (1.8% versus 0.7%, p=0.03; 15.2% versus 5.5%, p<0.001, respectively). Neither systolic nor diastolic function correlated with pregnancy outcome; however, left ventricular mass index (LVMi) weakly correlated with pre-eclampsia (5g/m2 increase: OR 1.18 [95% C.I. 1.01-1.38], p=0.04). Antenatal ß blockers (n=116) were associated with lower birthweight Z score (adjusted difference -0.33 [95% C.I. -0.63- -0.02], p=0.04). Conclusions: This study demonstrated a modest increase in preterm pre-eclampsia and significant increase in FGR in women with cardiac dysfunction. These results do not support a causal relationship between cardiac dysfunction and pre-eclampsia, especially accounting for the background risk status of the population. The mechanism underpinning the relationship between cardiac dysfunction and FGR merits further research but could be influenced by concomitant ß blocker use.
11 Mar 2022Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
16 Mar 2022Submission Checks Completed
16 Mar 2022Assigned to Editor
16 Mar 2022Reviewer(s) Assigned
12 Apr 2022Review(s) Completed, Editorial Evaluation Pending