Silversides et al., 2018


1) Examine cardiac complications during pregnancy and their temporal trends; and 2) Derive a risk stratification index.

1938 pregnancies were included

2 large Canadian tertiary care hospitals.

(Toronto and Vancouver)


Prospective descriptive design

Cardiac complications occurred in 16% of pregnancies and were primarily related to arrhythmias and heart failure. Although the overall rates of cardiac complications during pregnancy did not change over the years, the frequency of pulmonary edema decreased.

Ten predictors of maternal cardiac complications were identified: 5 general predictors (prior cardiac events or arrhythmias, poor functional class or cyanosis, high-risk valve disease/left ventricular outflow tract obstruction, systemic ventricular dysfunction, no prior cardiac interventions); 4 lesion-specific predictors (mechanical valves, high-risk aortopathies, pulmonary hypertension, coronary artery disease); and 1 delivery of care predictor (late pregnancy assessment). These 10 predictors were incorporated into a new risk index (CARPREG II [Cardiac Disease in Pregnancy Study]).

Balint et al., 2010


To examine the frequency and determinants of late cardiac events (LCE) in a large cohort of women with CHD.

405 pregnancies in 318 women

A tertiary care referral hospital, Canada

Prospective descriptive design

The median follow-up time was 2.6 years after pregnancy. LCE occurred after 12% (50/405) of pregnancies. The 5-year rate of LCE was higher in women with adverse cardiac events during pregnancy than in those without. Women at highest risk for LCE were those with functional limitations, cyanosis, ventricular dysfunction and left ventricular outflow tract obstruction. Three women (0.007%) died after pregnancy. The most common LCEs were arrhythmias which occurred in 35 women. Sixty-two pregnancies (15%) were followed by therapeutic cardiac interventions; the most common indications for intervention were arrhythmia and/or congestive heart failure (40%) or deterioration in functional capacity (38%). Approximately 1/10 pregnancies were followed by a LCE.