Obstetric and Cardiac Outcomes of Pregnant Women With Congenital Heart Disease by Functional Class [25N

Abstract

INTRODUCTION: Women with adult congenital heart disease (ACHD) are at risk for adverse outcomes during pregnancy. There are limited data on type and extent of adverse outcomes given the small population size and lack of centralized health data. METHODS: We conducted a retrospective cohort study of women with ACHD who received obstetric care at the University of Washington between 2010 and 2018 using medical record review. RESULTS: We identified 169 women who contributed 232 pregnancies (mean age at first pregnancy 29±5.7 years; median number total pregnancies 2, range 1–13). Most women had moderate ACHD lesions (70%); 38% were ACHD functional class C/D, and 20% were WHO pregnancy class III/IV. There were 3 induced abortions related to maternal cardiac disease and 15 miscarriages; no maternal deaths. Of 212 continuing pregnancies, 18% were preterm birth <37 weeks, 45% were cesarean deliveries, 7% had intrauterine growth restriction, and 2% were small for gestational age. There were 2 neonatal deaths. 23% of women did not have concurrent ACHD care. Hospitalizations for cardiac reasons occurred for 22% of pregnancies. Women experienced arrhythmias with 12% of pregnancies, heart failure with 3%, and 1 woman had a stroke. Combined cardiac outcome varied by functional class (OR for class C/D 8.10, 95% CI 1.01–64.68) but not ACHD lesion or WHO risk. Key obstetric outcomes (preterm birth, cesarean delivery, IUGR) did not vary by ACHD predictors. CONCLUSION: Maternal and fetal health outcomes were generally favorable. Preterm delivery and hospitalization rates were high. ACHD functional class may predict adverse events.