Severe Maternal Morbidity and Mortality in Women with Congenital Heart Disease [18R

Abstract

INTRODUCTION: Studies have demonstrated an increase in adverse pregnancy outcomes in women with congenital heart disease. We sought to examine the association of maternal congenital heart disease (CHD) with the risk of severe maternal morbidity and mortality (SMM) compared to women without congenital heart disease. METHODS: This retrospective cross-sectional study used 2008 through 2012 New York City (NYC) birth certificates linked to hospital discharge data to identify delivery hospitalizations. Cases of SMM were identified using ICD-9 diagnosis and procedure codes based on the Center for Disease Control and Prevention criteria. Data were limited to singleton, live births. CHD included women with any vascular, septal, or valvular abnormality of the heart at birth. Multivariable logistic regression was used to evaluate SMM in women with CHD adjusting for maternal demographics, socioeconomic status, and medical comorbidities. RESULTS: From 2008 through 2012 there were 578,840 live singleton births in NYC, 347 of these births were to women with CHD (6/10,000). Acute renal failure, adult respiratory distress syndrome, thrombotic embolism, cardiac arrest/ventricular fibrillation, pulmonary edema/heart failure, conversion of cardiac rhythm, and transfusion were all independently associated with CHD. Women who had CHD had higher adjusted odds of SMM(aOR 2.43; 95% CI 1.60-3.70) compared to women without CHD after adjusting for maternal socioeconomic status, demographics and medical comorbidities. There was one maternal death. CONCLUSION: SMM is increased in women with CHD, even after adjusting for co-morbid conditions. It is important that these women receive care from an identified multidisciplinary team from preconception to postpartum to optimize pregnancy outcomes.