Maternal heart disease and pregnancy complications: a tertiary hospital experience from Turkiye

Authors

Gülşan Karabay, Zeynep Şeyhanlı, Ahmet Arif Filiz, Hatice Ayhan, Selma İpek, Umut Karabay, Ali Çağlar
https://doi.org/10.18621/eurj.1626635
Objectives: Maternal heart disease is a leading cause of non-obstetric maternal mortality and morbidity, complicating the necessary physiological changes during pregnancy. This study aimed to evaluate maternal and perinatal outcomes in pregnancies complicated by maternal heart disease.
Methods: A retrospective analysis was conducted from November 2022 to November 2023 at a tertiary care hospital. Ninety-three pregnant women with maternal heart disease were included and categorized into congenital heart disease, rheumatic heart disease, and other cardiac conditions. Data on demographics, obstetric complications, and perinatal outcomes were analyzed.
Results: Among the participants, 47.3% had rheumatic heart disease, 37.6% had other cardiac conditions, and 15.1% had congenital heart disease. Maternal outcomes included a 29% incidence of preterm delivery, and an 8.6% occurrence of fetal growth restriction, and 7.5% of mothers requiring postpartum intensive care. However, no maternal mortality was observed. Neonatal outcomes included a 30.3% admission rate to the neonatal intensive care unit and a 12.9% incidence of respiratory distress syndrome, with no recorded fetal mortality. Outcomes were consistent across the three cardiac disease groups, demonstrating the effectiveness of multidisciplinary care approaches.
Conclusions: Early diagnosis, individualized care, and multidisciplinary management are essential for improving outcomes in pregnancies with maternal heart disease. Despite no observed maternal or fetal mortality, high rates of preterm births and neonatal complications emphasize the need for targeted interventions. Addressing modifiable risk factors like hypertension and obesity is critical. Multicenter studies with larger cohorts are recommended to enhance management strategies.
Maternal heart disease, pregnancy outcomes, rheumatic heart disease, neonatal complications, high-risk pregnancies

1. Eggleton EJ, McMurrugh KJ, Aiken CE. Perinatal outcomes in pregnancies complicated by maternal cardiomyopathy: a systematic review and meta-analysis. Am J Obstet Gynecol. 2023;228(3):283-291. doi: 10.1016/j.ajog.2022.09.025.

2. Knight M, Nair M, Brocklehurst P, et al. Examining the impact of introducing ICD-MM on observed trends in maternal mortality rates in the UK 2003-13. BMC Pregnancy Childbirth. 2016;16(1):178. doi: 10.1186/s12884-016-0959-z.

3. Yucel A, Koksal Z, Ensari T, et al. Maternal mortality due to valvular heart disease: a population-based study in Turkey. Ir J Med Sci. 2022;191(6):2531-2537. doi: 10.1007/s11845-021-02879-7.

4. Múnera-Echeverri AG. [Heart disease and pregnancy]. Rev Colomb Cardiol. 2018;25(S1):49-58. doi: 10.1016/j.rccar.2017.11.028. [Article in Spanish]

5. Nguyen Manh T, Bui Van N, Le Thi H, et al. Pregnancy with Heart Disease: Maternal Outcomes and Risk Factors for Fetal Growth Restriction. Int J Environ Res Public Health. 2019;16(12):2075. doi: 10.3390/ijerph16122075.

6. Kearney K, Zentner D, Cordina R. Management of Maternal Complex Congenital Heart Disease During Pregnancy. Curr Heart Fail Rep. 2021;18(6):353-361. doi: 10.1007/s11897-021-00534-x.

7. Chapman AB, Abraham WT, Zamudio S, et al. Temporal relationships between hormonal and hemodynamic changes in early human pregnancy. Kidney Int. 1998;54(6):2056-2063. doi: 10.1046/j.1523-1755.1998.00217.x.

8. Mahendru AA, Everett TR, Wilkinson IB, Lees CC, McEniery CM. A longitudinal study of maternal cardiovascular function from preconception to the postpartum period. J Hypertens. 2014;32(4):849-856. doi: 10.1097/HJH.0000000000000090.

9. Parsonage WA, Zentner D, Lust K, Kane SC, Sullivan EA. Heart Disease and Pregnancy: The Need for a Twenty-First Century Approach to Care…. Heart Lung Circ. 2021;30(1):45-51. doi: 10.1016/j.hlc.2020.06.021.

10. Gelson E, Johnson M. Effect of maternal heart disease on pregnancy outcomes. Expert Rev Obstet Gynecol. 2010;5(5):605-617. doi: 10.1586/eog.10.49.

11. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-3241. doi: 10.1093/eurheartj/ehy340.

12. Lammers AE, Diller G-P, Lober R, et al. Maternal and neonatal complications in women with congenital heart disease: a nationwide analysis. Eur Heart J. 2021;42(41):4252-4260. doi: 10.1093/eurheartj/ehab571.

13. Meng M-L, Arendt KW. Obstetric Anesthesia and Heart Disease: Practical Clinical Considerations. Anesthesiology. 2021;135(1):164-183. doi: 10.1097/ALN.0000000000003833.

14. Vural T, Bayraktar B, Yildirim Karaca S, et al. Comparison of Maternal, Perinatal, and Neonatal Outcomes of Asymptomatic and Symptomatic Pregnant Women with Coronavirus Disease-2019. Medeni Med J. 2022;37(1):44-53. doi: 10.4274/MMJ.galenos.2022.47600.

15. Gonzalez JM, Harris I, Jimenez Ramirez N, et al. Maternal cardiac disease and perinatal outcomes in a single tertiary care center. J Matern Fetal Neonatal Med. 2023;36(2):2223336. doi: 10.1080/14767058.2023.2223336.

16. Foeller ME, Foeller TM, Druzin M. Maternal Congenital Heart Disease in Pregnancy. Obstet Gynecol Clin North Am. 2018;45(2):267-280. doi: 10.1016/j.ogc.2018.01.011.

17. Arnoni RT, Arnoni AS, Bonini RCA, et al. Risk factors associated with cardiac surgery during pregnancy. Ann Thorac Surg. 2003;76(5):1605-1608. doi: 10.1016/S0003-4975(03)01188-3.

18. Subbaiah M, Sharma V, Kumar S, et al. Heart disease in pregnancy: cardiac and obstetric outcomes. Arch Gynecol Obstet. 2013;288(1):23-27. doi: 10.1007/s00404-013-2730-2.

19. Madazli R, Sal V, Cift T, Guralp O, Goymen A. Pregnancy outcomes in women with heart disease. Arch Gynecol Obstet. 2010;281(1):29-34. doi: 10.1007/s00404-009-1050-z.

20. Drenthen W, Pieper PG, Roos-Hesselink JW, et al.; ZAHARA Investigators. Outcome of Pregnancy in Women With Congenital Heart Disease: A Literature Review. J Am Coll Cardiol. 2007;49(24):2303-2311. doi: 10.1016/j.jacc.2007.03.027.

21. Beaton A, Okello E, Scheel A, et al. Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting. Heart. 2019;105(10):755-760. doi: 10.1136/heartjnl-2018-313810.

22. Liaw J, Walker B, Hall L, Gorton S, White AV, Heal C. Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis. PloS One. 2021;16(6):e0253581. doi: 10.1371/journal.pone.0253581.

23. Khanna R, Chandra D, Yadav S, et al. Maternal and fetal outcomes in pregnant females with rheumatic heart disease. Indian Heart J. 2021;73(2):185-189. doi: 10.1016/j.ihj.2021.01.012.

24. Rezk M, Gamal A.: Maternal and fetal outcome in women with rheumatic heart disease: a 3-year observational study. Arch Gynecol Obstet. 2016;294:273-278. doi: 10.1007/s00404-015-3990-9. Retracted Article.

There are 24 references in total.
1.
Karabay G, Şeyhanlı Z, Filiz AA, et al. Maternal heart disease and pregnancy complications: a tertiary hospital experience from Turkiye. Eur Res J. 2025;11(2):151-160. doi:10.18621/eurj.1626635

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Article Information

  • Article Type Research Article
  • Submitted February 21, 2026
  • Published March 3, 2025
  • Issue Vol. 11 No. 2 (2025)
  • Section Research Article
  • File Downloads 449
  • Abstract Views 183
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