Funding outcome

Heart disease during pregnancy affects about 4% of all pregnancies and is the leading cause of maternal death. This includes women born with heart conditions as well as those who develop heart disease later in life. The number of affected pregnancies is increasing because advances in medical care allow more children with heart disease to survive into adulthood, and many are having children at older ages. Although most individuals with heart disease can become pregnant, these pregnancies carry higher risks for both mother and baby, including heart rhythm problems, heart failure, high blood pressure disorders of pregnancy, preterm birth, and babies who are smaller than expected at birth. In a healthy pregnancy, the mother's heart must pump 30-45% more blood to meet the needs of the growing baby and placenta. This is supported by changes in heart function and relaxation of the blood vessels, which lowers resistance to blood flow. In those with heart disease, these changes may not occur adequately. Some individuals cannot increase blood flow due to weakened heart muscle, valve disease, or stiff blood vessels. Not all individuals with heart disease who experience complications have obvious heart failure, suggesting that blood vessel health may play an important role. This study uses data collected over the past five years from a prospective research study of pregnant mothers with and without (healthy controls) heart disease. We will analyze heart ultrasound scans performed at 28-34 weeks of pregnancy, when the strain on the heart is greatest. A key focus is ventricular-arterial coupling, which reflects how well the heart and blood vessels work together. Earlier results from the second trimester showed a mismatch between heart function and blood vessels in mothers with heart disease, especially in those with more severe disease. We hypothesize this mismatch will worsen later in pregnancy and may be linked to worse pregnancy outcomes for the mother and her baby.