Pregnancy Outcomes in Women With Congenital Heart Disease

Abstract

Background— Pregnant women with congenital heart disease are at increased risk for cardiac and neonatal complications, yet risk factors for adverse outcomes are not fully defined. Methods and Results— Between January 1998 and September 2004, 90 pregnancies at age 27.7±6.1 years were followed in 53 women with congenital heart disease. Spontaneous abortions occurred in 11 pregnancies at 10.8±3.7 weeks, and 7 underwent elective pregnancy termination. There were no maternal deaths. Primary maternal cardiac events complicated 19.4% of ongoing pregnancies, with pulmonary edema in 16.7% and sustained arrhythmias in 2.8%. Univariate risk factors included prior history of heart failure (odds ratio [OR], 15.5), NYHA functional class ≥2 (OR, 5.4), and decreased subpulmonary ventricular ejection fraction (OR, 7.7). Independent predictors were decreased subpulmonary ventricular ejection fraction and/or severe pulmonary regurgitation (OR, 9.0) and smoking history (OR, 27.2). Adverse neonatal outcomes occurred in 27.8% of ongoing pregnancies and included preterm delivery (20.8%), small for gestational age (8.3%), respiratory distress syndrome (8.3%), intraventricular hemorrhage (1.4%), intrauterine fetal demise (2.8%), and neonatal death (1.4%). A subaortic ventricular outflow tract gradient >30 mm Hg independently predicted an adverse neonatal outcome (OR, 7.5). Cardiac risk assessment was improved by including decreased subpulmonary ventricular systolic function and/or severe pulmonary regurgitation (OR, 10.3) in a previously proposed risk index developed in pregnant women with acquired and congenital heart disease. Conclusions— Maternal cardiac and neonatal complication rates are considerable in pregnant women with congenital heart disease. Patients with impaired subpulmonary ventricular systolic function and/or severe pulmonary regurgitation are at increased risk for adverse cardiac outcomes.

Pregnancy and heart disease: risk and predictors of obstetric complications

“…The rate of preterm labor (7%), respiratory distress syndrome (10%) and low APGAR scores at birth (6%) are comparable to previous studies by Khairy P et al 20 The high rate of small for gestational age fetuses (31%) is not comparable with western studies probably due to difference in the ethnic group studied and hence the difference in birth weights.…”

“…As in the present study, the most common cardiac complications have consistently been congestive heart failure. Most cardiac events (75%) occurred in the antepartum period and the results are comparable to 82% obtained by Siu S C et al 19 Neonatal complications occurred in 31% of pregnancies, comparable to the 27.8% reported by Khairy P et al 20 However, the high maternal mortality rate of 2% and fetal/neonatal mortality rate of 4% is not comparable with western studies. The low maternal and neonatal mortality observed in those studies may be due to greater vigilance in the care of pregnant women with heart disease or the avoidance of pregnancy by women in higher-risk groups.…”

Adult Congenital Heart Disease in a Nationwide Population 2000–2014: Epidemiological Trends, Arrhythmia, and Standardized Mortality Ratio

“…The higher proportion of labor as the causes of death in simple ACHD patients compared with severe ACHD patients may simply reflect the fact that so few of the severe ACHD patients were able or advised to carry a pregnancy. Maternal cardiac and neonatal complication rates were extremely high in pregnant women with CHD 20. Labor may, at least partially, account for the excessive mortality in women with simple ACHD.…”

Pulmonary hypertension and pregnancy—a review of 12 pregnancies in nine women

“…15,16 Although our patient group is clearly too small to make any statement about the relation of arrhythmias to prognosis, maternal arrhythmia has been associated with increased cardiac events during pregnancy 17 and adverse fetal outcomes. 18 Management Anticoagulation Seven of the nine women in our series were anticoagulated with subcutaneous LMWH; (the degree of anticoagulation was based on their estimated thrombotic risk). Patients who had been taking warfarin before pregnancy were fully anticoagulated with subcutaneous LMWH, monitored by measuring anti-factor Xa levels (target 0.6-1).…”