Characteristics and outcomes of socioeconomically disadvantaged pregnant individuals with adult congenital heart disease presenting to a Cardio-Obstetrics Program

Abstract

Outcomes of individuals with adult congenital heart disease (ACHD) who are socioeconomically disadvantaged and cared for in a cardio-obstetric programs are lacking. To describe clinical characteristics, maternal pregnancy outcomes and contraceptive uptake of individuals with ACHD in an urban cardio-obstetric program. Retrospective data were collected for individuals with ACHD seen in the Maternal Fetal Medicine-Cardiology Joint Program at Montefiore Health System between 2015-2021 and compared by modified World Health Organization (mWHO) class I,II vs. mWHO ≥II/III. Over 90% of individuals with ACHD were pregnant at the time of referral. mWHO I,II (n=77, 62.4% Black or Hispanic/Latina) had a total of 94 pregnancies and mWHO ≥II/III (n=49, 49.0% Black or Hispanic/Latina), a total of 56 pregnancies. Over 25% of individuals in each group had a body mass index ≥30 (p=0.78), as well as very low summary socioeconomic scores. mWHO ≥II/III were more likely to be anticoagulated in the first trimester than mWHO I, II (10.7% vs. 0.0%, p=0.002) and throughout pregnancy (14.3% vs 3.2% p=0.02). mWHO ≥II/III were more likely to require arterial monitoring during delivery than mWHO I, II (14.3% vs. 0.0%, p=0.001) or delivery under general anesthesia (8.9% vs. 1.1%, p=0.03), but had a comparable frequency of Cesarean delivery (35.8% vs. 41.3%, p=0.68). There were no in-hospital maternal deaths. There was no difference in the type of contraception recommended by mWHO class, however, mWHO ≥II/III were more likely to receive long acting types or permanent sterilization (35.6% vs 54.6%, p=0.045). In a socioeconomically disadvantaged cohort with ACHD from a historically marginalized community, those with mWHO ≥II/III had more complex antepartum and intrapartum needs, but similar maternal and obstetric outcomes as mWHO I,II. The multidisciplinary approach offered by a cardio-obstetrics program may contribute to successful outcomes in this high-risk cohort and these data are hypothesis generating.