Secondary Analysis Defining ≤28 Weeks Gestational Cutoff for Comprehensive Multidisciplinary Care in Cardiac Pregnancy: STROBE-Compliant Prospective Cohort from Safdarjung Hospital

Background Optimal gestational timing for multidisciplinary care in cardiac pregnancy remains undefined in low-middle income countries (LMICs), where heart disease drives 15–27% maternal deaths. Methods Secondary analysis of a prospective cohort (October 2014-March 2016, n = 66) at Safdarjung Hospital, stratified by care initiation: Group A (≤ 28 weeks comprehensive medical care [CMC], n = 32) vs. Group B (> 28 weeks standard care, n = 34). Primary outcome: maternal cardiac events (ESC 2025 criteria). Results Cardiac events: 15.6% (A) vs. 20.6% (B); cardiac mortality: 0% vs. 5.6% (p = 0.61). LSCS for cardiac indication: 35.7% vs. 18.1%. Neonatal mortality: 0% vs. 5.6%. Early CMC reduced events 1.3-fold. Conclusions ≤28 weeks CMC cutoff prevents 5.6% absolute increase in RHD-dominant LMIC pregnancies. Primary care triage ≤ 28 weeks is recommended to meet WHO MMR targets.