Maternal and Neonatal Outcomes in Women With Congenital Heart Disease at a Single Academic Center [32L

Abstract

INTRODUCTION: Maternal congenital cardiac disease contributes to maternal and neonatal morbidity and mortality. We sought to describe both maternal and neonatal outcomes in women with congenital heart disease delivering at an academic medical center. METHODS: We conducted a retrospective review of pregnancies occurring in women with congenital heart disease who received prenatal care and delivered at Vanderbilt University Medical Center between 2009 – 2015. RESULTS: A total of 48 women experiencing 52 pregnancies were included. Majority of subjects were Caucasian (76.9%) who utilized public insurance (65.4%). 39 women (75%) had surgically repaired lesions and 14 (26.9%) reported a prior cardiac event. The majority of lesions were WHO class I/II (75%). Maternal ICU admissions occurred in 13.5% of patients and 3.8% of patients had postpartum readmission. 11.5% patients had a cardiac event during peripartum period. Obstetrical complications included preterm birth (15.7%); fetal growth restriction (22%); and admission to NICU (16%). Congenital heart disease was diagnosed in 14% of infants. 49% were delivered via cesarean delivery with an additional 15.7% having operative vaginal deliveries. Epidural anesthesia was administered in 74% of patients. CONCLUSION: Pregnancy in women with congenital heart disease is associated with increased maternal and neonatal morbidity and mortality. Our results are similar to previously published data regarding risks of maternal cardiac events, preterm birth, fetal growth restriction and recurrent congenital heart disease. A collaborative care model with adult congenital cardiology, obstetric anesthesia, neonatology, and maternal fetal medicine is necessary to evaluate maternal and neonatal risk in women with congenital heart disease.