CHENNAI: After a recently published study found that maternal mortality is higher among women with heart diseases, the Institute of Cardiology at the Madras Medical College has roped in 23 government and six private institutions in the Madras Medical College Pregnancy and Cardiac (M-PAC) registry with 2,995 women being enrolled to improve care and reduce deaths. A national registry is also in the works with 20 states expressing interest.
“Maternal mortality is 35 times higher in pregnant women with heart diseases. While other causes of maternal deaths are given importance, cardiac problem in pregnant women needs special extra care than what it is getting now. Maternal deaths due to this cause also should be reduced to bring down the maternal mortality rate (MMR) in state further,” said Dr G Justin Paul, professor, Institute of Cardiology, Madras Medical College, and principal author of the study which was published in the European Heart Journal, a peer-reviewed medical journal of cardiology published by Oxford University.
The study conducted on consecutive pregnancies in 1,005 pregnant women with heart diseases at the Madras Medical College and its affiliated institutions found that among them maternal mortality is highest in women with prosthetic heart valves.
The researchers had formed the M-PAC registry which enrolled pregnant women with heart diseases who visited the Government Institute of Obstetrics and Gynaecology, Egmore, Kasturba Gandhi Hospital for Women and Women, Triplicane, and Rajiv Gandhi Government General Hospital from July 2016 to December 2019.
According to the study, 1,029 consecutive pregnancies in women with heart diseases were prospectively followed up throughout pregnancy and post-partum. The study found that maternal mortality was high in pregnant women (1.9%) with heart diseases, with highest death rates in women with prosthetic heart valves (8.6%).
The study reveals that the majority (60.5%) in the cohort had heart disease diagnosed for the first time during pregnancy, while rheumatic heart disease (42%) was the most common condition followed by pulmonary hypertension (34.2%).
According to the study, the c-statistics of modified WHO (mWHO) classification for predicting maternal cardiac events and maternal death were 0.794 and 0.796 respectively. The mWHO classification provides a first impression about the potential risk of pregnancy
Cardiac events were recorded in 15.2% pregnancies in the study. Heart failure was the most common maternal cardiac event (66%). Maternal mortality was recorded 1.9% cases in the study, and highest in patients with prosthetic heart valves.
The study also observed that low and middle-income countries need to focus on cardiac-obstetric approach, early diagnosis and pre-conception counselling. Tamil Nadu’s MMR has dropped to 54 per one lakh live births in 2018-2020 from 58 in 2017-2019, as per data released by the Union Health Ministry.