Abstract 15749: Long-Term Vascular Events in Pregnant Women With Congenital Heart Disease: The Magee Obstetric Maternal and Infant (MOMI) ACHD Substudy

Abstract

Introduction: Data on long-term post-delivery risk for vascular events, including cerebrovascular and thromboembolic (TE) events, among women with adult congenital heart disease (ACHD), are limited. Hypothesis: Risk for vascular events remains elevated in the long-term after delivery in pregnant women with ACHD. Methods: Data from the University of Pittsburgh Medical Center clinical data warehouse were linked to all deliveries from 2004 to 2020 in pregnant women with ACHD (N=430) and without ACHD (N=876), who were included in the Magee Obstetric Maternal and Infant (MOMI) study. Women were matched at the delivery level for age, delivery year, and race. Ischemic and TE vascular events were captured until 8/31/2022. Cerebrovascular events were captured with codes I6X.X (ICD-10) and 43X.X (ICD-9); venous TE events with I82.X, I26.X, 453.X, and 415.X; arterial TE with I74.X, I75.X, 444.X, and 445.X; and acute coronary events with I20.X, I21.X, I24.X, 410.X, and 413.X. Kaplan-Meier (K-M) estimates were used for incidence and compared with Cox proportional hazards models. Results: Baseline characteristics and pregnancy outcomes are presented in Table 1 . After a median of 5.1 (2.8, 8.8) years, women with ACHD experienced 24 cerebrovascular events (5-year K-M: 5.2%), compared to 8 events (5-year K-M: 0.3%) in controls (HR 7.00; 95%CI 3.14 - 15.6; P<0.001), and 8 venous TE (5-year K-M: 2.6%) vs. 11 (5-year K-M: 1.0%) events, (HR 1.69; 95%CI 0.68 - 4.18; P=0.26), Fig. 1 . There were no arterial TE events. Only 1 woman (with ACHD) experienced an acute coronary event. Conclusions: Women with ACHD remain at elevated risk for cerebrovascular but not venous TE events in the long-term after delivery.