Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry

Introduction: Congenital heart disease (CHD) is becoming an increasingly important cause of heart disease in pregnancy in low- and middle - income countries (LMICs). Preconception and contraception counselling based on risk stratification has the potential to reduce maternal complications. Data is l...

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Autores principales:	Justin Paul Gnanaraj, Anne Princy S, Anju Surendran S
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Counselling Pregnancy Congenital heart disease Preconception Contraception Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/9cf24e40a1e64ba6bbb8cb4ca746f704
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spelling	oai:doaj.org-article:9cf24e40a1e64ba6bbb8cb4ca746f7042021-11-06T04:37:57ZCounselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry2666-668510.1016/j.ijcchd.2021.100207https://doaj.org/article/9cf24e40a1e64ba6bbb8cb4ca746f7042021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666668521001312https://doaj.org/toc/2666-6685Introduction: Congenital heart disease (CHD) is becoming an increasingly important cause of heart disease in pregnancy in low- and middle - income countries (LMICs). Preconception and contraception counselling based on risk stratification has the potential to reduce maternal complications. Data is lacking from LMICs on the availability and effectiveness of preconception counselling (PCC) in women with CHD (WWCHD). Methods: Madras Medical College Pregnancy and Cardiac disease (M-PAC) Registry is a single center prospective observational registry conducted at a tertiary referral institution in South India from July 2016 to December 2019. Baseline features and feto-maternal outcomes were compared in WWCHD with and without PCC. Predictors of post-delivery contraception were identified. Results: Of the 107 eligible pregnancies with data on counselling, only 49.5% had received PCC. Pregnancies involving women with corrected CHDs (62.3% vs 33.3%; P = 0.006) and cyanotic CHD (20.8% vs 11.1%; P = 0.042) were more likely to get PCC. High risk mWHO categories were non-significantly less likely to get PCC (32% vs 39%). Primary outcome of death or heart failure was non-significantly low in the PCC group (3.8% vs 7.4% P = 0.4). Patients with high risk m WHO categories were less likely to get Tier I contraceptives post-delivery (46% vs 79.7% P = 0.004). Conclusion: Preconception and post conception counselling, which have the potential to improve outcome in WWCHD, are being underused in LMICs. Health care systems should ensure multidisciplinary pregnancy and heart team approach to offer timely lesion specific pre-conceptional counselling, shared decision making and appropriate peri-pregnancy care for WWCHD.Justin Paul GnanarajAnne Princy SAnju Surendran SElsevierarticleCounsellingPregnancyCongenital heart diseasePreconceptionContraceptionDiseases of the circulatory (Cardiovascular) systemRC666-701ENInternational Journal of Cardiology Congenital Heart Disease, Vol 5, Iss , Pp 100207- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Counselling Pregnancy Congenital heart disease Preconception Contraception Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Counselling Pregnancy Congenital heart disease Preconception Contraception Diseases of the circulatory (Cardiovascular) system RC666-701 Justin Paul Gnanaraj Anne Princy S Anju Surendran S Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry
description	Introduction: Congenital heart disease (CHD) is becoming an increasingly important cause of heart disease in pregnancy in low- and middle - income countries (LMICs). Preconception and contraception counselling based on risk stratification has the potential to reduce maternal complications. Data is lacking from LMICs on the availability and effectiveness of preconception counselling (PCC) in women with CHD (WWCHD). Methods: Madras Medical College Pregnancy and Cardiac disease (M-PAC) Registry is a single center prospective observational registry conducted at a tertiary referral institution in South India from July 2016 to December 2019. Baseline features and feto-maternal outcomes were compared in WWCHD with and without PCC. Predictors of post-delivery contraception were identified. Results: Of the 107 eligible pregnancies with data on counselling, only 49.5% had received PCC. Pregnancies involving women with corrected CHDs (62.3% vs 33.3%; P = 0.006) and cyanotic CHD (20.8% vs 11.1%; P = 0.042) were more likely to get PCC. High risk mWHO categories were non-significantly less likely to get PCC (32% vs 39%). Primary outcome of death or heart failure was non-significantly low in the PCC group (3.8% vs 7.4% P = 0.4). Patients with high risk m WHO categories were less likely to get Tier I contraceptives post-delivery (46% vs 79.7% P = 0.004). Conclusion: Preconception and post conception counselling, which have the potential to improve outcome in WWCHD, are being underused in LMICs. Health care systems should ensure multidisciplinary pregnancy and heart team approach to offer timely lesion specific pre-conceptional counselling, shared decision making and appropriate peri-pregnancy care for WWCHD.
format	article
author	Justin Paul Gnanaraj Anne Princy S Anju Surendran S
author_facet	Justin Paul Gnanaraj Anne Princy S Anju Surendran S
author_sort	Justin Paul Gnanaraj
title	Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry
title_short	Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry
title_full	Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry
title_fullStr	Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry
title_full_unstemmed	Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry
title_sort	counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from madras medical college pregnancy and cardiac disease (m-pac) registry
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/9cf24e40a1e64ba6bbb8cb4ca746f704
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Counselling and pregnancy outcomes in women with congenital heart disease- current status and gap analysis from Madras Medical College Pregnancy And Cardiac disease (M-PAC) registry

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