The Canadian journal of cardiology | 2021
Cardiac Risk Score to Predict Small-for-Gestational-Age Infants in Pregnant Women with Heart Disease.
Abstract
BACKGROUND\nOne of the most common fetal complications in pregnant women with cardiovascular disease is small for gestational age (SGA) which is associated with a higher risk of perinatal morbidity/mortality and poor long-term health outcomes. The objective of this study was to identify cardiac determinants/derive a risk score of clinically relevant SGA < 5th percentile (SGA-5th).\n\n\nMETHODS\nA prospective cohort of 1812 pregnancies in women with heart disease was studied. SGA-5th was the outcome of interest, defined as birth weight less than 5th percentile for gestational age and sex. Multivariable logistic regression analysis identified predictors for SGA-5th. Based on the regression coefficients a weighted risk score was created.\n\n\nRESULTS\nSGA-5th complicated 10% of pregnancies, eleven predictors of SGA-5th were identified and each was assigned a weighted score: maternal cyanosis (8), Fontan palliation (7), smoking (3), moderate or severe valvular regurgitation (3), beta-blocker use throughout pregnancy (4) or only in the 2nd and 3rd trimester (2), high baseline beta-blocker dose (4), BMI < 18.5 (3) or 18.5-24.9 (1), Asian/other ethnicity (2) and significant outflow tract obstruction (1). In the absence of identified risk factors, the risk of SGA-5th was approximately 4%. Pregnancies with risk scores/SGA-5th rate were as follows: 0/4%, 1/5%, 2/7%, 3/9%, 4/12%, 5/14%, 6/18%, 7/23%, 8/28% and ≥ 9/34%.\n\n\nCONCLUSIONS\nThere are a number of cardiac predictors that are associated with increased risk of SGA-5th. This is a prognostically important outcome and consideration should be given to routinely predicting and modifying the risk whenever possible.