Table 1

Examples of studies with reports on maternal and fetal outcome in pregnant women with heart diseases

Study	Description	General maternal outcome	%	Obstetric/fetal outcome	%
Sliwa K et al15 2020 JACC Heart Fail	Maternal and fetal outcomes of women with uncorrected CHD (n=1059). 10-year data from the European Society of Cardiology registry including 53 countries	Maternal mortality	0.7	Pregnancy induced hypertension	4
		Major adverse cardiac events (MACE)	11.6	HELLP or pre/eclampsia	4
		Heart failure	8.7	Caesarean section	42
		Hospitalisation during pregnancy	15	Post-partum haemorrhage	4
		Supraventricular and ventricular arrhythmia	0.6	Premature birth	13.8
		Endocarditis and thromboembolism	1.1	Intra uterine growth retardation	7
				Low Apgar score	6
				Fetal death	1
				Neonatal death	1.5
				Adverse fetal outcome	17.2
Khairy P et al 2006. Circulation19	Pregnancy outcomes in women with CHD in a single centre, Brigham and Women’s Hospital, Boston, MA, USA. (n=53 women with total of 90 pregnancies).	Pulmonary oedema	16.7	Adverse neonatal outcomes	27.8
		Sustained arrhythmia	2.8	Pre-term delivery	20.8
		Maternal death	0	Small for gestational age	8.3
		Combined maternal cardiac events	19.4	Respiratory distress syndrome	8.3
				Intrauterine fetal death	2.8
				Neonatal death	1.4
				Spontaneous abortion	12.2
				Elective pregnancy termination	7.8
Drenthen W et al 2007. J Am Coll ardiol.24	A literature review on complications associated with pregnancy in women with structural CHD from 1985 to 2007. (n=2491 pregnancies)	Heart failure	4.8	Overall miscarriages	15
		Arrhythmias	4.5	Overall elective abortion	5
		Overall mortality	4	Overall fetal mortality	4
		Thromboembolic complications	2.2	Overall premature birth	16
		Thromboembolic complications	2.2	Pre-eclampsia	3.2
Ford AA et al 2008. Obstet Gynecol.20	Retrospective analysis of contemporary perinatal and cardiac outcomes of pregnancies in women with major structural CHD from 2000 to 2007. Single Centre study Columbia University Medical Center, New York. (n=69 women with 74 deliveries)	Combined adverse cardiac events	20.2	Combined adverse obstetric events	45.9
		Maternal death	7	Caesarean delivery	41.9
		Heart failure	9.5	Pre-eclampsia	9.5
		Significant arrhythmias	2.7	Pre-term delivery	17.7
		Significant arrhythmias	2.7	Small for gestational age	21.6
Warrik C et al 2015. J Clin Anesth.21	A retrospective analysis of women who delivered at the University of Colorado Hospital. (n=18 226, with 110 with CHD and 117 pregnancies)	Maternal death	0.9	Fetal death	0.8
Rezk M et al 2016 Arch Gynecol Obstet26	Prospective assessment of maternal and fetal outcome in women with RHD. 3-year, single-centre observational study in Egypt (n=192 pregnant women with RHD)	Heart failure	24.5	Small for gestational age	19.8
		Significant arrhythmias	9.9	Prematurity	26.0
		Thromboembolism	10.9	Intra-uterine fetal death	2.6
		Delivery by caesarean section	50	Neonatal ICU admission	34.9
		Post-partum haemorrhage	12.5	Neonatal death	3.1
		Maternal mortality	2.6	Neonatal death	3.1
Lin JH et al 2007. Zhonghua Fu Chan Ke Za Zhi.28	Single-centre evaluation of pregnant women with RHD from January 1993 to July 2006 in China (n=65)	Peri-natal mortality	5	Pre-term labour	28
				Medical abortion	18.9
				Intra-uterine fetal retardation	6
Sartain JB et al 2012 Intern Med J27	Single-centre maternal cardiac complications and obstetric outcomes in patients with RHD in Australia from 1999 to 2010. (n=54 women with total of 95 pregnancies)	Maternal death	0	Neonatal death	0
		Cardiac complications	8	Caesarean section	32.6
		Cardiac complications	8	Post-partum haemorrhage	2.1
Stergiopoulos K et al 2015, Am J Cardiol22	Risk and risk factors for adverse maternal and fetal events in pregnant women with underlying heart disease in New York. (n=173 pregnancies)	Heart failure	23	Underweight	21
		Sustained arrhythmia	19	Premature birth	19
		Maternal clinical events	49	Respiratory distress	19
		MACE	20	Fetal death	2
				Preterm labour	11
				Preterm delivery	18
				Fetal adverse clinical events	22
Siu et al3 2011 Circulation	Prospective multicenter (13 centres) study of pregnancy outcomes in women with heart disease in Canada. (n=562 women with 599 pregnancies).	Maternal primary cardiac event	13	Combined neonatal complications	20
		Combined maternal primary and secondary cardiac events	17	Small for gestational age	3.7
		CVA	0.6	Premature delivery	17.5
				Fetal death	1
				Neonatal death	1
				Preterm labour	10
Avila et al23 2003 Clin Cardiology	Single-centre outcome of pregnant women with cardiac disease in Brazil. (n=1000)	Heart failure	12%	Stillbirth	2.9
		Cardiac arrhythmias	6	Prematurity	12
		Thromboembolism	2	CHD	2.2
		Angina	1.4
		Infective endocarditis	0.5
		Maternal mortality	2.7
Campanharo et al25 2015 PLOS one	Cross-sectional study of all deliveries in 27 referral obstetric units in Brazil. (n=9555 pregnant women; 293 with heart disease)	Hospital admission	24	Neonatal death	4.1
Campanharo et al25 2015 PLOS one		Maternal death	4.8	Low birth weight	45
Roos-Hesselink et al2 2013, European Heart Journal	Outcome of pregnancy in patients with structural or ischaemic heart disease in Europe. (n=1321 pregnant women)	Maternal death	1	Caesarean section	41
		All hospitalisation	26	Fetal mortality	1.7
		Heart failure hospitalisation	10.1	Neonatal mortality	0.6
		Supra ventricular arrhythmias	0.9	Pregnancy induced hypertension	2.4
		Ventricular arrhythmias	2.0	Pre-eclampsia	3.3
				Caesarean section	41
				Post-partum haemorrhage	2.9

CHD, congenital heart disease; HELLP, Hemolysis, Elevated Liver enzymes and Low Platelets; RHD, rheumatic heart disease.