[Skip to Content]
[Skip to Content Landing]
Views 2,876
Citations 0
Original Investigation
April 12, 2017

Maternal and Fetal Outcomes of Admission for Delivery in Women With Congenital Heart Disease

Author Affiliations
  • 1Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
  • 2now with Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Memorial Medical Center, Worcester
  • 3Division of Cardiology, Department of Medicine, University of California, San Francisco
JAMA Cardiol. Published online April 12, 2017. doi:10.1001/jamacardio.2017.0283
Key Points

Question  How do the risks and outcomes for labor and delivery compare in women with and without congenital heart disease?

Findings  In this study capturing nearly every delivery admission in California during a 7-year period, congenital heart disease was associated with incident heart failure, atrial arrhythmias, fetal growth restriction, and readmission; complex congenital heart disease was also associated with ventricular arrhythmias and maternal in-hospital mortality, although these outcomes were rare, even in women with congenital heart disease.

Meaning  This study highlights some of the peripartum and postpartum risks for women with CHD, findings that may guide monitoring decisions and risk assessment for pregnant women with CHD at the time of delivery.

Abstract

Background  Women with congenital heart disease (CHD) may be at increased risk for adverse events during pregnancy and delivery.

Objective  To compare delivery outcomes between women with and without CHD.

Design, Setting, and Participants  This retrospective study of inpatient delivery admissions in the Healthcare Cost and Utilization Project’s California State Inpatient Database compared maternal and fetal outcomes between women with and without CHD by using multivariate logistic regression. Female patients with codes for delivery from the International Classification of Diseases, Ninth Revision, from January 1, 2005, through December 31, 2011, were included. The association of CHD with readmission was assessed to 7 years after delivery. Cardiovascular morbidity and mortality were hypothesized to be higher among women with CHD. Data were analyzed from April 4, 2014, through January 23, 2017.

Exposures  Noncomplex and complex CHD.

Main Outcomes and Measures  Maternal outcomes included in-hospital arrhythmias, eclampsia or preeclampsia, congestive heart failure (CHF), length of stay, preterm labor, anemia complicating pregnancy, placental abnormalities, infection during labor, maternal readmission at 1 year, and in-hospital mortality. Fetal outcomes included growth restriction, distress, and death.

Results  Among 3 642 041 identified delivery admissions, 3189 women had noncomplex CHD (mean [SD] age, 28.6 [7.6] years) and 262 had complex CHD (mean [SD] age, 26.5 [6.8] years). Women with CHD were more likely to undergo cesarean delivery (1357 [39.3%] vs 1 164 509 women without CHD [32.0%]; P < .001). Incident CHF, atrial arrhythmias, ventricular arrhythmias, and maternal mortality were uncommon during hospitalization, with each occurring in fewer than 10 women with noncomplex or complex CHD (<0.5% each). After multivariate adjustment, noncomplex CHD (odds ratio [OR], 9.7; 95% 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. Similar odds were found for atrial arrhythmias in noncomplex (OR, 8.2; 95% CI, 3.0-22.7) and complex (OR, 31.8; 95% CI, 4.3-236.3) CHD, for fetal growth restriction in noncomplex (OR, 1.6; 95% CI, 1.3-2.0) and complex (OR, 3.5; 95% CI, 2.1-6.1) CHD, and for hospital readmission in both CHD groups combined (OR, 3.6; 95% CI, 3.3-4.0). Complex CHD was associated with greater adjusted odds of serious ventricular arrhythmias (OR, 31.8; 95% CI, 4.3-236.3) and maternal in-hospital mortality (OR, 79.1; 95% CI, 23.9-261.8).

Conclusions and Relevance  In this study of hospital admissions for delivery in California, CHD was associated with incident CHF, atrial arrhythmias, and fetal growth restriction and complex CHD was associated with ventricular arrhythmias and maternal in-hospital mortality, although these outcomes were rare, even in women with complex CHD. These findings may guide monitoring decisions and risk assessment for pregnant women with CHD at the time of delivery.

×