Due to advances in cardiac care, the number of adults living with congenital heart disease (CHD) is increasing. Women with CHD who become pregnant face a specialized set of challenges and an increased risk of adverse outcome. Risk factors associated with adverse obstetrical and neonatal outcomes are incompletely understood. The primary aim of this study was to determine what cardiac risk factors are associated with preterm birth (PTB) and low birth weight (LBW).
A retrospective cohort study examined outcomes in women with CHD who delivered between1998-2010. We collected maternal cardiac, obstetrical, neonatal and echocardiographic data for analysis. The rates of adverse obstetrical and neonatal outcomes were determined and baseline cardiac characteristics were examined using Fishers exact test to assess the strength of association with adverse outcomes.
The study included 64 women with CHD (1 mild, 45 moderate, 22 complex heart defects) who had a total of 68 pregnancies. Only 29 women had preconception cardiac evaluation at an adult congenital heart disease center. An adverse obstetrical or neonatal outcome occurred in 41.1% (n=28) of pregnancies and included any of the following: PTB, LBW, pre-eclampsia, preterm rupture of membranes, or hemorrhage. The rate of PTB was 36.7% (n=25) and LBW was 27.9% (n=19). Factors associated with sustaining a PTB or LBW included the need for cardiac medications prior to pregnancy, moderate/severe tricuspid valve regurgitation, and moderate to severe right ventricular dysfunction (p≤0.05). The rate of cesarean delivery was 50.7%.
A significant number of women with CHD undergoing pregnancy will experience an adverse obstetrical or neonatal outcome. Right heart failure, as evidenced by moderate to severe RV dysfunction and/or moderate to severe tricuspid valve regurgitation is associated with an increased risk of PTB and LBW. A larger cohort is needed to confirm these findings. Given the high rate of adverse outcomes, women with CHD should be cautioned about fetal as well as maternal cardiac risks associated with pregnancy.
© 2012 Mosby, Inc. Published by Elsevier Inc. All rights reserved.