ScholarWorks@성균관대학교

초록

Background: Valvular heart disease (VHD) during pregnancy is associated with significant maternal and neonatal risks. While large-scale cohort studies have documented these risks in western populations, evidence in Korean women remains limited. This study aimed to evaluate maternal and neonatal outcomes by VHD severity and identify predictors of adverse events to inform risk assessment. Methods: This retrospective study included 138 pregnant women with VHD who delivered at Samsung Medical Center between December 1994 and June 2023. Patients were stratified by VHD severity. The primary outcomes were adverse maternal outcomes, defined as maternal death or pregnancy-related complications requiring hospitalization, and adverse neonatal events, defined as neonatal intensive care unit admission or fetal death. Results: Mitral regurgitation was the most common lesion (47.8%). The incidence of adverse maternal outcomes increased with VHD severity (P = 0.007), mainly driven by heart failure hospitalizations. In age-adjusted Cox models, moderate (hazard ratio [HR], 3.6) and severe VHD (HR, 9.8) were associated with higher maternal risk. Independent predictors of adverse maternal outcomes in multivariable analysis included New York Heart Association (NYHA) ≥ 2 in the first trimester (odds ratio [OR], 3.27; P = 0.028), prior hospitalization for acute decompensated heart failure (ADHF) before pregnancy (OR, 6.59; P = 0.002), and moderate (OR, 6.27; P = 0.019) or severe VHD (OR, 7.36; P = 0.025). For neonatal outcomes, NYHA ≥ 2 (OR, 3.75; P = 0.026) and ADHF hospitalization during pregnancy (OR, 3.87; P = 0.029) were significant predictors. Conclusion: VHD severity was associated with maternal heart failure hospitalization, but functional status and prior decompensation were equally important. These findings highlight the importance of pre-pregnancy evaluation and structured perinatal care. Multidisciplinary management may reduce complications, even in high-risk patients.

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