Maternal Outcomes in Women With Congenital Heart Disease

Study Questions:

What are the outcomes of hospital admissions for delivery between women with and without congenital heart disease (CHD)?

Methods:

A retrospective review was performed using California’s Health Cost and Utilization Project’s State Inpatient Database. Maternal and fetal outcomes for patients with and without congenital heart disease were compared using multivariate logistic regression. The association of CHD with readmission was assessed to 7 years after delivery. Data were analyzed from April 4, 2014 through January 23, 2017.

Results:

A total of 3,642,041 delivery admissions were studied, including 3,189 women with noncomplex and 262 with complex CHD. Women with CHD were more likely to undergo caesarean delivery than those without CHD (39.3% vs. 32%, p < 0.001). Cardiac complications, including incident congestive heart failure (CHF), atrial arrhythmias, ventricular arrhythmias, and maternal mortality were uncommon in all groups, occurring in <0.5% of admissions. After multivariate adjustment, both noncomplex (odds ratio [OR], 9.7; 95% confidence interval [CI], 4.7-20.0) and complex CHD (OR, 56.6; 95% CI, 17.6-182.5) were associated with greater odds of incident CHF. Complex CHD was associated with greater adjusted odds of serious ventricular arrhythmia (OR, 31.8; 95% CI, 4.3-236.3) and maternal in-hospital mortality (OR, 79.1; 95% CI, 23.9-261.8). Median length of stay was longer and chance of readmission to the hospital was both higher in women with CHD as compared with those without.

Conclusions:

Although serious adverse events were rare, CHD was associated with increased complications as compared with the general population. The rate of cesarean delivery was significantly higher in patients with CHD.

Perspective:

This retrospective study investigated delivery outcomes for women with CHD in California. The study supports existing research suggesting that, although serious complications are relatively rare in women with CHD, they occur at a higher rate than in patients without CHD. The relatively high rate of cesarean delivery in women with CHD is interesting because it is required for cardiac indications in relatively rare circumstances.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Quality Improvement, Acute Heart Failure

Keywords: Arrhythmias, Cardiac, Cesarean Section, Delivery, Obstetric, Heart Defects, Congenital, Heart Failure, Hospital Mortality, Inpatients, Length of Stay, Maternal Mortality, Outcome Assessment (Health Care), Patient Readmission, Pregnancy


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