Reproductive & Maternal Health Resource Center

Reproductive & Maternal Health Resource Center

Disclosures: The authors report no relevant financial disclosures.
March 12, 2021
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Obesity elevates CV complication risk in pregnant women with heart disease

Disclosures: The authors report no relevant financial disclosures.
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Obesity increased risk for CV complications in pregnant women with preexisting heart disease, according to results published in the Journal of the American College of Cardiology.

“Adverse maternal cardiac events during pregnancy are common in women with heart disease and vary according to the underlying cardiac condition. ... A common and potentially modiable risk factor associated with adverse cardiovascular outcomes during pregnancy is maternal obesity,” Birgit Pfaller, MD, from the pregnancy and heart disease program at Mount Sinai and Toronto General Hospitals, and colleagues wrote. “Although maternal obesity is an important determinant of cardiovascular complications in the pregnant population, its impact on outcomes in pregnant women with preexisting heart disease has not been studied.”

Obesity increased risk for CV complications in pregnant women with preexisting heart disease. Data were derived from Pfaller B, et al. J Am Coll Cardiol. 2021;doi:10.1016/j.jacc.2021.01.010.

In a single-center, prospective cohort study, researchers analyzed 790 pregnancies (600 women with heart disease) for adverse maternal cardiac events associated with BMI status. Further analysis utilized the Canadian Cardiac Disease in Pregnancy Study (CARPREG) II scoring to predict cardiac complications. Researchers categorized weight status as underweight (BMI < 18.5 kg/m2), normal (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29.9 km/m2) and obese (BMI 30 kg/m2).

Of the studied pregnancies, 19% occurred in women categorized as obese, 25% occurred in women categorized as overweight, 53% occurred in women categorized as normal and 3% occurred in women categorized as underweight.

According to the researchers, women with obesity had a higher risk for cardiac events compared with women with normal weight (23% vs. 14%; P = .006). In multivariable analysis, obesity (OR = 1.7; 95% CI, 1-2.7; P= .04) and increased CARPREG II risk score (OR = 1.7; 95% CI, 1.5-1.9; P < .001) were independent predictors of cardiac events.

In addition, preeclampsia was more common in women with obesity than in women with normal weight (8% vs. 2%; P = .001), the researchers wrote.

“Pregnancy in women with heart disease and obesity is associated with higher rates of maternal and perinatal complications when compared with women with normal weight,” Pfaller and colleagues wrote. “Pregnant women with heart disease and obesity should be educated about these risks and health care providers should ensure that dietary advice, weight gain recommendations and comorbidities are addressed as part of routine care.”