Medical and Obstetric Outcomes Among Pregnant Women With Congenital Heart Disease

Abstract

Objective: To estimate nationwide trends in the prevalence of maternal congenital heart disease (CHD) and determine whether women with CHD are more likely than women without maternal CHD to have medical and obstetric complications.

Methods: The 2000-2010 Nationwide Inpatient Sample was queried for International Classification of Diseases, 9th Revision, Clinical Modification codes to identify delivery hospitalizations of women with and without CHD. Trends in the prevalence of CHD were determined and then rates of complications were reported for CHD per 10,000 delivery hospitalizations. For Nationwide Inpatient Sample 2008-2010, logistic regression was used to examine associations between CHD and complications.

Results: From 2000 to 2010, there was a significant linear increase in the prevalence of CHD from 6.4 to 9.0 per 10,000 delivery hospitalizations (P<.001). Multivariable logistic regression demonstrated that all selected medical complications, including mortality (17.8 compared with 0.7/10,000 deliveries, adjusted odds ratio [OR] 22.10, 95% confidence interval [CI] 13.96-34.97), mechanical ventilation (91.9 compared with 6.9/10,000, adjusted OR 9.94, 95% CI 7.99-12.37), and a composite cardiovascular outcome (614 compared with 34.3/10,000, adjusted OR 10.54, 95% CI 9.55-11.64) were more likely to occur among delivery hospitalizations with maternal CHD than without. Obstetric complications were also common among women with CHD. Delivery hospitalizations with maternal CHD that also included codes for pulmonary circulatory disorders had higher rates of medical complications compared with hospitalizations with maternal CHD without pulmonary circulatory disorders.

Conclusion: The number of delivery hospitalizations with maternal CHD in the United States is increasing, and although we were not able to determine whether correction of the cardiac lesion affected outcomes, these hospitalizations have a high burden of medical and obstetric complications.

Level of evidence: II.

Fig. 1

Trend in delivery hospitalizations among women with congenital heart disease per 10,000. There was a significant linear increase in the delivery hospitalizations of women with congenital heart disease from 6.4 (95% confidence interval [CI] 6.2–6.7) per 10,000 delivery hospitalizations in 2000 to 9.0 (95% CI 8.7–9.3) per 10,000 delivery hospitalizations in 2010 (R²=0.91, P<.001). Error bars at each point estimate are 95% CIs. Thompson. Maternal Congenital Heart Disease and Outcomes. Obstet Gynecol 2015.