Receipt of American Heart Association-Recommended Preconception Health Care Among Privately Insured Women With Congenital Heart Defects, 2007-2013

Abstract

Background Our objective was to estimate receipt of preconception health care among women with congenital heart defects (CHD), according to 2017 American Heart Association recommendations, as a baseline for evaluating recommendation implementation. Methods and Results Using 2007 to 2013 IBM MarketScan Commercial Databases, we identified women with CHD diagnosis codes ages 15 to 44 years who became pregnant and were enrolled in health insurance for ≥11 months in the year before estimated conception. We assessed documentation of complete blood count, electrolytes, thyroid-stimulating hormone, liver function, ECG, comprehensive echocardiogram, and exercise stress test, using procedural codes, and outpatient prescription claims for US Food and Drug Administration category D and X cardiac-related medications. Differences were examined according to CHD severity, age, region of residence, year of conception, and documented encounters at obstetric and cardiology practices. We found 2524 pregnancies among 2003 women with CHD (14.4% severe CHD). In the 98.3% of women with a healthcare encounter in the year before conception, <1% received all and 22.6% received no American Heart Association-recommended tests or assessments (range: 54.4% for complete blood count to 3.1% for exercise stress test). Women with the highest prevalence of receipt of recommended care were 35 to 44 years old, pregnant in 2012 to 2013, or had a documented obstetric or cardiology encounter in the year before conception (P<0.05 for all). In 9.0% of pregnancies, ≥1 prescriptions for US Food and Drug Administration category D or X cardiac-related medications were filled in the year before conception. Conclusions A low percentage of women with CHD received American Heart Association-recommended preconception health care in the year before conception.

Keywords: congenital cardiac defect; preconception; pregnancy.

Figure 1

Exclusion criteria and final sample size of women with healthcare claim(s) for congenital heart defect (CHD)* who became pregnant^†, IBM MarketScan Commercial Databases. *1 inpatient and/or ≥2 outpatient claims ≥30 days apart; ^†Pregnancy based on documentation of end of pregnancy procedure and diagnostic codes and estimated last menstrual period occurring 2008 to 2013; ^&ddagger;Enrolled for ≥11 months on plan with prescription drug coverage.

Figure 2

Receipt of American Heart Association–recommended tests and assessments in the year before conception among women with congenital heart defects (CHD) and 1 or more healthcare encounters in the year before conception, IBM MarketScan Commercial Databases, 2007–2013. CBC indicates complete blood count; TSH, thyroid‐stimulating hormone.