PMID- 36817227
OWN - NLM
STAT- MEDLINE
DCOM- 20230227
LR  - 20230303
IS  - 2211-8179 (Electronic)
IS  - 2211-8160 (Print)
IS  - 2211-8160 (Linking)
VI  - 18
IP  - 1
DP  - 2023
TI  - Outcomes in Pregnant Women with Valvular Heart Disease from Portuguese-Speaking 
      African Countries Treated in Portugal through an International Agreement of 
      Health Cooperation.
PG  - 4
LID - 10.5334/gh.1183 [doi]
LID - 4
AB  - AIMS: We performed a clinical audit of maternal and fetal outcomes in pregnant 
      women with valvular heart disease (VHD) from Portuguese-speaking African 
      countries who were transferred for their care, during a twenty-year period, 
      through a memorandum of agreement of international cooperation. METHODS AND 
      RESULTS: A retrospective analysis of 81 pregnancies in 45 patients with VHD 
      (median age 24, interquartile range 22-29 years) from 2000 to 2020 was performed. 
      The main outcome measures were maternal cardiovascular and fetal outcomes. 
      History of rheumatic heart disease was present in 60 (74.1%) pregnancies. Most 
      were in New York Heart Association (NYHA) functional class I or II; at the first 
      evaluation, 35 (43.2%) were on cardiac medication and 49 (60.5%) were 
      anticoagulated. Forty-eight pregnancies had at least one valvular prosthesis, 
      including 38 mechanical heart valves. During pregnancy, deterioration in NYHA 
      functional class occurred in 35 (42.0%), and eight (9.9%) patients required 
      initiation or intensified cardiac medication. Mechanical valve thrombosis 
      complicated four (4.9%) pregnancies, all cases on heparin, and resulted in one 
      maternal death. Haemorrhagic complications happened in 7 (8.6%) anticoagulated 
      patients, in the immediate postpartum or puerperal period. The 81 pregnancies 
      resulted in 56 (69.1%) live births, while miscarriage and fetal malformations 
      occurred in 19 (23.5%) and 12 (14.8%) pregnancies, respectively. In multivariate 
      analysis, vitamin K antagonist therapy was the only independent predictor of an 
      unsuccessful pregnancy (p = 0.048). CONCLUSION: In a high-income country, 
      successful pregnancy was possible with low rate of maternal events in women with 
      VHD transferred from five low-middle income countries in Africa. The use of 
      anticoagulation with a vitamin K antagonist was associated with an unsuccessful 
      pregnancy.
CI  - Copyright: (c) 2023 The Author(s).
FAU - Ferreira, Vera Vaz
AU  - Ferreira VV
AUID- ORCID: 0000-0002-8957-9279
AD  - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar 
      Universitario de Lisboa Central, Lisbon, PT.
FAU - Monteiro, Andre Viveiros
AU  - Monteiro AV
AD  - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar 
      Universitario de Lisboa Central, Lisbon, PT.
FAU - Moreira, Rita Ilhao
AU  - Moreira RI
AD  - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar 
      Universitario de Lisboa Central, Lisbon, PT.
FAU - Plancha, Marta
AU  - Plancha M
AD  - Department of Obstetrics and Gynecology, Maternidade Alfredo da Costa, Centro 
      Hospitalar Universitario de Lisboa Central, Lisbon, PT.
FAU - Machado, Ana Isabel
AU  - Machado AI
AD  - Department of Obstetrics and Gynecology, Maternidade Alfredo da Costa, Centro 
      Hospitalar Universitario de Lisboa Central, Lisbon, PT.
FAU - Castelo, Alexandra
AU  - Castelo A
AD  - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar 
      Universitario de Lisboa Central, Lisbon, PT.
FAU - Bras, Pedro Garcia
AU  - Bras PG
AD  - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar 
      Universitario de Lisboa Central, Lisbon, PT.
FAU - Mano, Tania Branco
AU  - Mano TB
AD  - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar 
      Universitario de Lisboa Central, Lisbon, PT.
FAU - Alves, Maria Jose
AU  - Alves MJ
AD  - Department of Obstetrics and Gynecology, Maternidade Alfredo da Costa, Centro 
      Hospitalar Universitario de Lisboa Central, Lisbon, PT.
FAU - Thomas, Boban
AU  - Thomas B
AD  - The Heart Centre, Hospital Cruz Vermelha Portuguesa, Lisbon, PT.
FAU - Ferreira, Rui Cruz
AU  - Ferreira RC
AD  - Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar 
      Universitario de Lisboa Central, Lisbon, PT.
FAU - Patricio, Lino
AU  - Patricio L
AD  - Cardiology Department and CRIA/Cerebro-Cardiovascular Responsability Centre, 
      Hospital do Espirito Santo, Evora, PT.
LA  - eng
PT  - Journal Article
DEP - 20230213
PL  - England
TA  - Glob Heart
JT  - Global heart
JID - 101584391
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 12001-79-5 (Vitamin K)
SB  - IM
MH  - Pregnancy
MH  - Female
MH  - Humans
MH  - Young Adult
MH  - Adult
MH  - Pregnancy Outcome
MH  - Portugal
MH  - Pregnant Women
MH  - Retrospective Studies
MH  - *Pregnancy Complications, Cardiovascular
MH  - *Heart Valve Diseases/surgery
MH  - Anticoagulants/therapeutic use
MH  - Fibrinolytic Agents/therapeutic use
MH  - Vitamin K
PMC - PMC9936910
OTO - NOTNLM
OT  - Portuguese-speaking African countries
OT  - intergovernmental health agreements
OT  - mechanical heart valves
OT  - pregnancy outcomes
OT  - valvular heart disease
COIS- The authors have no competing interests to declare.
EDAT- 2023/02/24 06:00
MHDA- 2023/03/03 06:00
PMCR- 2023/02/13
CRDT- 2023/02/23 09:32
PHST- 2022/07/10 00:00 [received]
PHST- 2023/01/12 00:00 [accepted]
PHST- 2023/02/23 09:32 [entrez]
PHST- 2023/02/24 06:00 [pubmed]
PHST- 2023/03/03 06:00 [medline]
PHST- 2023/02/13 00:00 [pmc-release]
AID - 10.5334/gh.1183 [doi]
PST - epublish
SO  - Glob Heart. 2023 Feb 13;18(1):4. doi: 10.5334/gh.1183. eCollection 2023.