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Pregnancy Complications in Women With Congenital Heart Disease
Study Questions:
What are the differences in comorbidities and adverse pregnancy-related events and outcomes in women with congenital heart defects (CHDs) as compared with the general population?
Methods:
The National Inpatient Sample was used to study comorbidities and adverse delivery events in women with and without CHDs in 22,881,691 deliveries in the United States. For women with CHDs, associations by CHD severity and the presence of pulmonary hypertension (PH) were examined.
Results:
A total of 17,729 deliveries to women with CHDs were identified, occurring at a rate of 77.5 out of 100,000 deliveries. Women with CHDs had longer length of stay and higher total hospital charges than women without CHDs. Comorbidities, including PH (adjusted odds ratio [aOR], 193.8; 95% confidence interval [CI], 157.7-238.0), congestive heart failure (aOR, 49.1; 95% CI, 37.4-64.3), and coronary artery disease (aOR, 31.7; 95% CI, 21.4-47.0) were more common in patients with CHDs. Greater risks of both cardiac and obstetric adverse events were seen in patients with CHDs, including heart failure (aOR, 22.6; 95% CI, 20.5-37.3), arrhythmias (aOR, 12.4; 95% CI, 11.0-14.0), thromboembolic events (aOR, 1.5; 95% CI, 1.2-1.8), pre-eclampsia (aOR, 1.5; 95% CI, 1.3-1.7), and placenta previa (aOR, 1.5; 95% CI, 1.2-1.8). Caesarian delivery, induction, and operative vaginal delivery were more common in women with CHDs, while fetal distress was less common.
Conclusions:
Pregnant women with CHDs were more likely to have comorbidities and experience adverse events during delivery.
Perspective:
This study made use of the National Inpatient Sample to identify pregnancy complication rates in women with congenital heart disease in the United States. Both cardiac and obstetric adverse events occurred at a higher rate in women with congenital heart disease than those without. This study confirms previous research demonstrating increased risk for obstetric and cardiac complications in women with congenital heart disease. The primary limitation of the study is related to miscoding or incomplete coding within the National Inpatient Sample. The study supports the need for multidisciplinary care for pregnant women with congenital heart disease to establish patient-specific plans for pregnancy, delivery, and the postpartum period.
Keywords: Arrhythmias, Cardiac, Cesarean Section, Comorbidity, Coronary Artery Disease, Delivery, Obstetric, Fetal Distress, Heart Defects, Congenital, Heart Failure, Hospital Charges, Hypertension, Pulmonary, Inpatients, Length of Stay, Parturition, Placenta Previa, Postpartum Period, Pre-Eclampsia, Pregnancy, Thromboembolism, Women
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