Highlights
- •One third of pregnant women with heart disease used cardiac medication.
- •The use of cardiac medication was associated with adverse fetal events.
- •Birth weight was significantly lower in children of patients taking beta-blockers.
Abstract
Background
Data on pharmacological management during pregnancy are scarce. The aim of this study
was to describe the type and frequency of cardiac medication used in pregnancy in
patients with cardiovascular disease and to assess the relationship between medication
use and fetal outcome.
Methods and results
Between 2007 and 2011 sixty hospitals in 28 countries enrolled 1321 pregnant women.
All patients had structural heart disease (congenital 66%, valvular 25% or cardiomyopathy
7% or ischemic 2%). Medication was used by 424 patients (32%) at some time during
pregnancy: 22% used beta-blockers, 8% antiplatelet agents, 7% diuretics, 2.8% ACE
inhibitors and 0.5% statins. Compared to those who did not take medication, patients
taking medication were older, more likely to be parous, have valvular heart disease
and were less often in sinus rhythm. The odds ratio of fetal adverse events in users
versus non-users of medication was 2.6 (95% CI 2.0–3.4) and after adjustment for cardiac
and obstetric parameter was 2.0 (95% CI 1.4–2.7). Babies of patients treated with
beta-blockers had a significantly lower adjusted birth weight (3140 versus 3240 g, p = 0.002). The highest rate of fetal malformation was found in patients taking ACE inhibitors
(8%).
Conclusion
One third of pregnant women with heart disease used cardiac medication during their
pregnancy, which was associated with an increased rate of adverse fetal events. Birth
weight was significantly lower in children of patients taking beta-blockers. A randomized
trial is needed to distinguish the effects of the medication from the effects of the
underlying maternal cardiac condition.
Keywords
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Article info
Publication history
Published online: September 23, 2014
Accepted:
September 15,
2014
Received in revised form:
September 8,
2014
Received:
June 10,
2014
Footnotes
☆Funding sources: The ROPAC is included in the EurObservational Research Programme (EORP) of the European Society of Cardiology. The EurObservational Research Programme (EORP) was sponsored by the following companies: Abbott Vascular Int., Amgen, Bayer Pharma, Bristol Myers Squibb, Boehringer Ingelheim, Boston Scientific Int., Daiichi Sankyo Company, Menarini Int., Merck & Co., Inc. (MSD), Novartis, Pfizer, and Servier Int.
☆☆All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
