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Cardiology > CHF
Pregnancy is Riskier With Congenital Heart Defects
Study findings suggest additional care and monitoring
by Ashley Lyles, Staff Writer, MedPage Today April 29, 2019
Women with congenital heart defects (CHDs) had riskier pregnancies than other women, a study showed.
The odds of pre-eclampsia and placenta previa were 50% elevated compared with women who didn't have CHDs, while odds of arrhythmias were about 12-fold, elevated and thromboembolic event risk was doubled.
Operative vaginal delivery, induction, and cesarean section were more common with CHD as well, reported Lauren Schlichting, PhD, of Hassenfeld Child Health Innovation Institute in Providence, Rhode Island, and colleagues in the Journal of the American College of Cardiology.
While fetal distress was rarer with CHD, the adjusted odds of all other obstetric events were significantly more common, including hypertension in pregnancy, hemorrhage, placental abruption, and pre-term delivery. There were no differences by CHD severity in most adverse events.
This at-risk group warrants frequent prenatal evaluation, greater vigilance, and clear documentation of delivery and labor contingency planning, noted Ami Bhatt, MD, of Massachusetts General Hospital in Boston, in an accompanying editorial. "Multidisciplinary care involving cardiology, obstetrics, and obstetric anesthesia for individuals with CHD who become pregnant is essential, even in the mild-to-moderate CHD population."
Prior studies have demonstrated a similar increase in adverse fetal and maternal outcomes among pregnant women with CHD, noted Manisha Gandhi, MD, of Baylor College of Medicine in Houston, who was not involved in the study.
"This study had a large national database which allowed for more detailed evaluation of women by the severity of the type of congenital heart disease, which allows for better risk stratification," Gandhi told MedPage Today.
The adverse outcome risk "provides additional support of the importance of care in specialized centers with a multidisciplinary team approach for pregnant women with complex congenital heart disease," Gandhi continued.
Schlichting's group evaluated 17,729 deliveries among pregnant women with CHD, with a mean age of 27.7 years, and compared them with more than 22 million pregnant women without CHD, with a mean age of 27.8 years. Only 5% of the CHD patients had severe defects, 70% had mild-to-moderate defects, and 25% had an isolated atrial septal defect.
CHDs were associated with more comorbidities among pregnant women, including 31-fold higher adjusted odds of coronary artery disease, 49 times more risk of congestive heart failure, and nearly 200 times the likelihood of pulmonary hypertension (PH).
Adverse delivery events and comorbidities among women without and with CHDs were compared in the 2008 to 2013 National Inpatient Sample (NIS) using multivariable logistic regression.
Schlichting noted the limitations of the study included lack of patient-level information, which would have provided information for history of defect repair, for validation of CHD, and an assessment of how pregnancy might be effected among those with unrepaired and reported defects.
"In addition, we were unable to account for complications that occurred during pregnancy that were outside of the delivery hospitalization. Furthermore, the NIS does not provide any linkages to the infant's record and therefore, fetal complications were only ascertained from those listed on the maternal record and may be incomplete," Schlichting told MedPage Today.
Looking ahead, "more research is needed to determine whether management in centers with special expertise in CHD improves the outcomes of pregnancy," the researchers wrote.
This study was funded by the Centers for Disease Control and Prevention.
Schlichting and Bhatt reported no disclosures.
Source Reference: Schlichting LE, et al "Maternal comorbidities and complications of delivery in pregnant women with congenital heart disease" J Am Coll Cardiol 2019; DOI: 10.1016/j.jacc.2019.01.069.
Source Reference: Bhatt AB "Adverse delivery events in pregnant women with congenital heart defects: wish you an easy delivery" J Am Coll Cardiol 2019; DOI: 10.1016/j.jacc.2019.02.038.
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