Background—The maternal and neonatal risks associated with pregnancy in women with heart disease receiving
comprehensive prenatal care have not been well defined.
Methods and Results—We prospectively enrolled 562 consecutive pregnant women with heart disease and determined the
outcomes of 599 pregnancies not ending in miscarriage. Pulmonary edema, arrhythmia, stroke, or cardiac death
complicated 13% of pregnancies. Prior cardiac events or arrhythmia, poor functional class or cyanosis, left heart
obstruction, and left ventricular systolic dysfunction independently predicted maternal cardiac complications; the
cardiac event rate can be predicted using a risk index incorporating these predictors. Neonatal complications (20% of
pregnancies) were associated with poor functional class or cyanosis, left heart obstruction, anticoagulation, smoking,
and multiple gestations.
Conclusions—Pregnancy in women with heart disease is associated with significant cardiac and neonatal complications,
despite state-of-the-art obstetric and cardiac care. Maternal cardiac risk can be predicted with the use of a risk index