ABSTRACT
BACKGROUND AND OBJECTIVES: cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum. MATERIALS AND METHODS: Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment. RESULTS: 112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk. Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric haemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, pâ¯=â¯0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, pâ¯=â¯0.001) and heart failure (adjusted OR 16; 95% CI: 3-84, pâ¯=â¯0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, pâ¯=â¯0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, pâ¯=â¯0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, pâ¯=â¯0.021). CONCLUSIONS: severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.
ABSTRACT
BACKGROUND: Few studies have looked at the prevalence of substance use disorders (SUD) in people with intellectual disability (ID). The results range between 1% and 6.4% and go up to 20% in people with ID and psychiatric disorders, probably underestimating real prevalence due to several limitations in these studies. ID confers risk for the development of SUD, which in turn will involve negative psychosocial and clinical consequences. We aimed to study the prevalence of SUD in a sample of patients with ID admitted to a brief hospitalisation psychiatric unit, describing them by type and severity and analysing their relationship with clinical, prognostic and access to treatment variables. METHODS: We undertook a descriptive, cross-sectional and retrospective study by means of a review of clinical histories of all patients with a diagnosis of ID, admitted in a period of 10 years. RESULTS: Among the final sample of patients included, 52.3% had a mild ID, 40.9% an unspecified ID, 3.4% a moderate ID and another 3.4% a severe ID. More than one third of the sample met criteria for a SUD. The main SUD was cannabis use disorder (25%), followed by alcohol use disorder (22.7%) and cocaine use disorder (13.6%). The use of more than one substance was the most frequent pattern. Cannabis use disorder and cocaine use disorder were overrepresented in the group with mild ID. A greater number of psychiatric admissions was observed for the group with SUD. Specialised mental health services for ID and specialised addiction network facilities were much less involved in the care of these patients that could be expected according to good clinical practice recommendations. CONCLUSIONS: Substance use disorder in patients with ID and mental health disorders admitted to psychiatric hospitalisation are prevalent, which makes this issue an area of interest for future improvements in case identification, proper referring to specialised treatment resources and an increasing research focusing on specific therapeutic approaches.
