Pregnancy in women with congenital heart disease

Cauldwell, Matthew; Santos, Francois Dos; Steer, Philip; Swan, Lorna; Gatzoulis, Michael Α.; Johnson, Mark R.

doi:10.1136/bmj.k478

Cited by 26 publications

(16 citation statements)

References 55 publications

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“…This resulted in four themes, with three of them divided into subcategories (See Fig. 1): [1] experience with obstetric care, [2] feelings regarding pregnancy, [3] privacy and [4] impact on daily life, Participants did not provide feedback on the findings. Results were reported following the Consolidated criteria for Reporting Qualitaitve research Checklist (See Additional file 2).…”

Section: Discussionmentioning

confidence: 99%

“…Worldwide, the number of women at increased risk for complications in pregnancy continues to grow due to unhealthy lifestyle, obesity, advanced maternal age at conception and concurrent comorbidities [1][2][3]. High-risk pregnancy is defined as any pregnancy in which there is a factor-maternal or fetal-that potentially acts adversely to affect the outcome of pregnancy, for example preterm rupture of membranes (PROM), fetal growth restriction (FGR) and preeclampsia (PE) [4].…”

Section: Introductionmentioning

confidence: 99%

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Home-based telemonitoring versus hospital admission in high risk pregnancies: a qualitative study on women’s experiences

Heuvel

Teunis

Franx

et al. 2020

BMC Pregnancy Childbirth

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Background: Hospital admission during pregnancy complications is considered to be an event of significant impact. Besides conventional in-clinic maternal and fetal monitoring, recent technologies enable home-based telemonitoring with self-measurements in high risk pregnancy. This study is part of a feasibility pilot to explore the usability and acceptability of telemonitoring and aims to gain insight in the experiences and preferences of high risk pregnant women concerning the novel strategy of telemonitoring, opposed to women who were hospitalized in pregnancy. Methods: Using secured Facebook Groups, we conducted four online focus groups: two focus groups with women who were admitted during pregnancy (n = 11) and two with women who received home telemonitoring in the pilot phase (n = 11). The qualitative data were analyzed thematically. Results: Four major themes emerged from both participant groups: [1] care experience, [2] emotions regarding pregnancy, [3] privacy and [4] impact on daily life. Different views were reported on all four themes, resulting in a direct comparison of experiences during hospitalization and telemonitoring. Most admitted patients reported a growing sense of boredom and anxiety during their clinical admission. Lack of privacy on ward was a great concern, as it affected their contact with hospital staff and family. This issue was not reported amongst telemonitored women. These participants still felt like a patient at times but responded that the comfort of their own home and bed was pleasant. Only a minority of telemonitored participants reported being anxious at times at home, while not having a physician or nurse nearby. Being at home resulted in less travel time for partners or family for hospital visits, which had its positive effects on family life. Conclusions: Telemonitoring of a high-risk pregnancy provides an innovative manner to monitor fetal and maternal condition from home. Compared to the experiences of hospital admission in high risk pregnancy, it allows women to be in a comforting and private environment during an anxious time in their lives. As future studies should further investigate the safety and cost effectiveness of this novel strategy, women's views on the preference of telemonitoring need to be taken into consideration.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Home-based telemonitoring versus hospital admission in high risk pregnancies: a qualitative study on women’s experiences

Heuvel

Teunis

Franx

et al. 2020

BMC Pregnancy Childbirth

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“…This could be explained by increased risk of subfertility and fetal loss among women with CHD, potentially delaying pregnancy onset . Later, pregnancy may also have reflected temporal trends in medical practice, with clinicians advocating for better counseling and antenatal care in the more recent years rather than avoidance of pregnancy …”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19][20] Later, pregnancy may also have reflected temporal trends in medical practice, with clinicians advocating for better counseling and antenatal care in the more recent years rather than avoidance of pregnancy. 21,22 Women with CHD had more cesarean deliveries than those without. Several other investigators have also found higher cesarean section rates among women with CHD when compared to pregnant controls.…”

Section: Discussionmentioning

confidence: 99%

Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease

Bottega

Malhamé

Guo

et al. 2019

Congenital Heart Disease

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Background The number of women with congenital heart disease (CHD) of reproductive age is increasing, yet a description of trends in pregnancy and delivery outcomes in this population is lacking. Objective To assess secular trends in pregnancy rates, delivery outcomes, and related health care utilization in the adult female CHD population in Quebec, Canada. Methods The Quebec CHD database was used to construct a cohort with all women with CHD aged 18‐45 years between 1992 and 2004. Pregnancy and delivery rates were determined yearly and compared to the general population. Secular trends in pregnancy and delivery rates were assessed with linear regression. The cesarean delivery rate in the CHD population was compared to the general population. Predictors of cesarean section were determined with multivariable logistic regression. Cox regression, adjusted for comorbidities, was used to analyze the impact of cesarean sections on 1‐year health care use following delivery. Results About 14 878 women were included. A total of 10 809 pregnancies were identified in 5641 women, of whom 4551 (80%) and 2528 (45%) experienced at least one delivery and/or abortion, respectively. Absolute yearly numbers and rates of pregnancies and deliveries increased during the study period (P < .05). The increment in cesarean section rates was more pronounced among women with CHD than among the general population. Gestational diabetes (OR 1.50, 95% CI [1.13, 1.99]), gestational hypertension (OR 1.81, 95% CI [1.27, 2.57]), and preeclampsia (OR 1.59, 95% CI [1.11, 2.8]) were independent predictors of cesarean delivery. Cesarean sections were associated with postpartum cardiac‐hospitalization within 1 year following delivery (HR = 2.35, 95% CI [1.05, 5.28]). Conclusions Yearly numbers and rates of pregnancies and deliveries in adult females with CHD rose significantly during the study period. Cesarean sections led to increased health care utilization. Further research is required to determine causes of high cesarean section rates in this patient population.

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“…Occasionally, women become pregnant without prior counselling or sometimes they desire a pregnancy despite the advice against it. 7 The diversity of the anatomical and functional conditions of the heart defects in CCC restrict the creation of management protocols for eventual complications during pregnancy, delivery and postpartum. 7 However, knowledge of the most common complications that occur in the late postoperative period of CCC helps in the management of pregnancy in these patients.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge

Ávila¹,

Ribeiro²,

Rossi³

et al. 2019

Arquivos Brasileiros De Cardiologia

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Background: The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions. Objectives: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. Methods: During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 ± 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p < 0.05. Results: Only seventeen (40.5%) pregnancies had maternal and fetal uneventful courses. There were 13 (30.9%) maternal complications, two (4.7%) maternal deaths due to hemorrhage pos-partum and severe pre-eclampsia, both of them in women with hypoxemia. There were 7 (16.6%) stillbirths and 17 (40.5%) premature babies. Congenital heart disease was identified in two (4.1%) infants. Maternal and fetal complications were higher (p < 0.05) in women with hypoxemia. Conclusions: Pregnancy in women with CCC was associated to high maternal and offspring risks. Hypoxemia was a predictive variable of poor maternal and fetal outcomes. Women with CCC should be advised against pregnancy, even when treated in specialized care centers.

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Pregnancy in women with congenital heart disease

Cited by 26 publications

References 55 publications

Home-based telemonitoring versus hospital admission in high risk pregnancies: a qualitative study on women’s experiences

Home-based telemonitoring versus hospital admission in high risk pregnancies: a qualitative study on women’s experiences

Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease

Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge

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