{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T01:46:00Z","timestamp":1793324760354,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"47","license":[{"start":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T00:00:00Z","timestamp":1553472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100011010","name":"Zabawas Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011010","id-type":"DOI","asserted-by":"publisher"}]},{"name":"De Hoop Foundation"},{"name":"EORP"},{"name":"Abbott Vascular Int.","id":[{"id":"https:\/\/ror.org\/05d67dc31","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Amgen Cardiovascular"},{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004326","name":"Bayer AG","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004326","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001003","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001003","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008497","name":"Boston Scientific","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Bristol Myers Squibb"},{"name":"Pfizer Alliance"},{"DOI":"10.13039\/501100022274","name":"Daiichi Sankyo Europe GmbH","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100022274","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Alliance Daiichi Sankyo Europe GmbH"},{"DOI":"10.13039\/100004312","name":"Eli Lilly and Company","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004312","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Gedeon Richter Plc.","id":[{"id":"https:\/\/ror.org\/0033rtn64","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Menarini Int. Op."},{"name":"MSD-Merck & Co."},{"name":"Novartis Pharma AG"},{"DOI":"10.13039\/100004339","name":"Sanofi","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004339","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011725","name":"SERVIER","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,12,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Reducing maternal mortality is a World Health Organization (WHO) global health goal. Although maternal deaths due to haemorrhage and infection are declining, those related to heart disease are increasing and are now the most important cause in western countries. The aim is to define contemporary diagnosis-specific outcomes in pregnant women with heart disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>From 2007 to 2018, pregnant women with heart disease were prospectively enrolled in the Registry Of Pregnancy And Cardiac disease (ROPAC). Primary outcome was maternal mortality or heart failure, secondary outcomes were other cardiac, obstetric, and foetal complications. We enrolled 5739 pregnancies; the mean age was 29.5. Prevalent diagnoses were congenital (57%) and valvular heart disease (29%). Mortality (overall 0.6%) was highest in the pulmonary arterial hypertension (PAH) group (9%). Heart failure occurred in 11%, arrhythmias in 2%. Delivery was by Caesarean section in 44%. Obstetric and foetal complications occurred in 17% and 21%, respectively. The number of high-risk pregnancies (mWHO Class IV) increased from 0.7% in 2007\u20132010 to 10.9% in 2015\u20132018. Determinants for maternal complications were pre-pregnancy heart failure or New York Heart Association &amp;gt;II, systemic ejection fraction &amp;lt;40%, mWHO Class 4, and anticoagulants use. After an increase from 2007 to 2009, complication rates fell from 13.2% in 2010 to 9.3% in 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rates of maternal mortality or heart failure were high in women with heart disease. However, from 2010, these rates declined despite the inclusion of more high-risk pregnancies. Highest complication rates occurred in women with PAH.<\/jats:p>\n                    <jats:p\/>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehz136","type":"journal-article","created":{"date-parts":[[2019,3,8]],"date-time":"2019-03-08T15:15:21Z","timestamp":1552058121000},"page":"3848-3855","source":"Crossref","is-referenced-by-count":388,"title":["Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC)"],"prefix":"10.1093","volume":"40","author":[{"given":"Jolien","family":"Roos-Hesselink","sequence":"first","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , CA Rotterdam, The Netherlands"},{"name":"EURObservational Research Programme, European Society of Cardiology , 2035 route des Colles les Templiers, Sophia Antipolis, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Baris","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , CA Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Obstetric Medicine, Imperial College London , Kensington, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"De Backer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ghent University Hospital , Corneel Heymanslaan 10, Ghent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Otto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, UW School of Medicine , 1959 NE Pacific St, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariane","family":"Marelli","sequence":"additional","affiliation":[{"name":"Department of Cardiology, McGill University Faculty of Medicine, 3605 Rue de la Montagne, Montr\u00e9al, QC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Jondeau","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bichat-Claude Bernard Hospital , 46 Rue Henri Huchard, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Budts","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospitals Leuven , Herestraat 49, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine","family":"Grewal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of British Columbia , Faculty of Medicine, 2312 Pandosy St, Kelowna, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Sliwa","sequence":"additional","affiliation":[{"name":"Hatter Institute for Cardiovascular Research in Africa , Faculty of Health Sciences, University of Cape Town, Private Bag X3 7935, Observatory, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Parsonage","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Brisbane and Women's Hospital , Cnr Butterfield St and Bowen Bridge Road, Herston, QLD 4029, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo P","family":"Maggioni","sequence":"additional","affiliation":[{"name":"EURObservational Research Programme, European Society of Cardiology , 2035 route des Colles les Templiers, Sophia Antipolis, France"},{"name":"National Association of Hospital Cardiologists Research Center (ANMCO) , Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"van Hagen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , CA Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alec","family":"Vahanian","sequence":"additional","affiliation":[{"name":"EURObservational Research Programme, European Society of Cardiology , 2035 route des Colles les Templiers, Sophia Antipolis, France"},{"name":"Department of Cardiology, Bichat-Claude Bernard Hospital , 46 Rue Henri Huchard, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Tavazzi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maria Cecilia Hospital , Via Madonna di Genova, 1, 48033 Cotignola RA, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uri","family":"Elkayam","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Southern California , Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Boersma","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Erasmus Medical Center , CA Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of East Anglia , Faculty of Medicine, Norwich Research Park, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,3,25]]},"reference":[{"key":"2022102608021711600_ehz136-B1","doi-asserted-by":"crossref","first-page":"3165","DOI":"10.1093\/eurheartj\/ehy340","article-title":"2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy","volume":"39","author":"Regitz-Zagrosek","year":"2018","journal-title":"Eur Heart J"},{"key":"2022102608021711600_ehz136-B2","volume-title":"Saving Lives, Improving Mothers' Care\u2014Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2013\u201315","author":"Knight","year":"2017"},{"key":"2022102608021711600_ehz136-B3","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/S0140-6736(15)00838-7","article-title":". Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group","volume":"387","author":"Alkema","year":"2016","journal-title":"Lancet"},{"key":"2022102608021711600_ehz136-B4","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/S0140-6736(06)68397-9","article-title":"WHO analysis of causes of maternal death: a systematic review","volume":"367","author":"Khan","year":"2006","journal-title":"Lancet"},{"key":"2022102608021711600_ehz136-B5","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/AOG.0000000000001556","article-title":"Is the United States Maternal Mortality Rate Increasing? Disentangling trends from measurement issues Short title: U.S. Maternal Mortality Trends","volume":"128","author":"MacDorman","year":"2016","journal-title":"Obstet Gynecol"},{"key":"2022102608021711600_ehz136-B6","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1161\/CIRCULATIONAHA.105.589655","article-title":"Pregnancy outcomes in women with congenital heart disease","volume":"113","author":"Khairy","year":"2006","journal-title":"Circulation"},{"key":"2022102608021711600_ehz136-B7","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1093\/eurheartj\/ehq200","article-title":"Predictors of pregnancy complications in women with congenital heart disease","volume":"31","author":"Drenthen","year":"2010","journal-title":"Eur Heart J"},{"key":"2022102608021711600_ehz136-B8","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1161\/hc3001.093437","article-title":"Prospective multicenter study of pregnancy outcomes in women with heart 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pregnancy: the task force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC)","volume":"32","author":"Regitz-Zagrosek","year":"2011","journal-title":"Eur Heart J"},{"key":"2022102608021711600_ehz136-B13","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1002\/ejhf.594","article-title":"Pulmonary hypertension and pregnancy outcomes: data from the Registry Of Pregnancy and Cardiac Disease (ROPAC) of the European Society of Cardiology","volume":"18","author":"Sliwa","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2022102608021711600_ehz136-B14","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.bpobgyn.2014.03.003","article-title":"Pregnancy and pulmonary hypertension","volume":"28","author":"Pieper","year":"2014","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"2022102608021711600_ehz136-B15","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1086\/682230","article-title":"Statement on pregnancy in pulmonary hypertension from the Pulmonary Vascular Research Institute","volume":"5","author":"Hemnes","year":"2015","journal-title":"Pulm Circ"},{"key":"2022102608021711600_ehz136-B16","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1136\/heartjnl-2016-310003","article-title":"Pregnancy outcomes in patients with pulmonary arterial hypertension associated with congenital heart disease","volume":"103","author":"Ladouceur","year":"2017","journal-title":"Heart"},{"key":"2022102608021711600_ehz136-B17","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1136\/hrt.2010.202838","article-title":"Cardiac outcomes after pregnancy in women with congenital heart 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(ROPAC)","volume":"38","author":"Goland","year":"2017","journal-title":"Eur Heart J"},{"key":"2022102608021711600_ehz136-B24","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/j.jacc.2014.12.066","article-title":"Aortic dissection and mortality associated with pregnancy in the United States","volume":"65","author":"Sawlani","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2022102608021711600_ehz136-B25","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1093\/eurheartj\/ehi103","article-title":"Pregnancy and aortic root growth in the Marfan syndrome: a prospective study","volume":"26","author":"Meijboom","year":"2005","journal-title":"Eur Heart J"},{"key":"2022102608021711600_ehz136-B26","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1002\/ajmg.a.37694","article-title":"Pregnancy after aortic root replacement in Loeys-Dietz syndrome: high risk of aortic dissection","volume":"170","author":"Braverman","year":"2016","journal-title":"Am J Med Genet A"},{"key":"2022102608021711600_ehz136-B27","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1136\/heartjnl-2014-306497","article-title":"Is a planned caesarean section in women with cardiac disease beneficial?","volume":"101","author":"Ruys","year":"2015","journal-title":"Heart"},{"key":"2022102608021711600_ehz136-B28","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1161\/CIRCULATIONAHA.117.032561","article-title":"Pregnancy outcomes in women with rheumatic mitral valve disease: results from the registry of pregnancy and cardiac disease","volume":"137","author":"van Hagen","year":"2018","journal-title":"Circulation"},{"key":"2022102608021711600_ehz136-B29","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1161\/CIRCULATIONAHA.115.015242","article-title":"Pregnancy in women with a mechanical heart valve: data of the European Society of Cardiology Registry of Pregnancy and Cardiac Disease (ROPAC)","volume":"132","author":"van 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for anticoagulation in pregnant women with mechanical heart valves: what are the risks? A retrospective observational study","volume":"119","author":"Basude","year":"2012","journal-title":"BJOG"}],"container-title":["European Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/40\/47\/3848\/46638257\/eurheartj_40_47_3848.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurheartj\/article-pdf\/40\/47\/3848\/46638257\/eurheartj_40_47_3848.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,26]],"date-time":"2022-10-26T04:03:17Z","timestamp":1666756997000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurheartj\/article\/40\/47\/3848\/5419276"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,25]]},"references-count":32,"journal-issue":{"issue":"47","published-online":{"date-parts":[[2019,3,25]]},"published-print":{"date-parts":[[2019,12,14]]}},"URL":"https:\/\/doi.org\/10.1093\/eurheartj\/ehz136","relation":{},"ISSN":["0195-668X","1522-9645"],"issn-type":[{"value":"0195-668X","type":"print"},{"value":"1522-9645","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,12,14]]},"published":{"date-parts":[[2019,3,25]]}}}