In the Journals

Cardiac complications during delivery elevated in women with congenital heart disease vs. general population

Women with congenital heart disease had more complications during hospitalization for delivery vs. women without a heart defect, although occurrences were uncommon, according to findings published in JAMA Cardiology.

“Owing to improvements in the treatment of congenital heart disease, most patients with [congenital heart disease] now survive to adulthood, and more than 1 million adults are living with [congenital heart disease] in the United States,” Robert M. Hayward, MD, assistant professor at the University of Massachusetts Medical School, and colleagues wrote in the study background. “As patients with congenital heart disease live longer, arrhythmias are an increasing cause of morbidity and mortality. In addition, more women with congenital heart disease are becoming pregnant, and these patients are at increased risk for arrhythmias and congestive HF.”

As a part of the Healthcare Cost and Utilization Project’s California database, women who gave birth from 2005 to 2011 were included in the study. Of the 3.6 million identified deliveries, 3,189 women had noncomplex congenital heart disease and 262 had complex congenital heart disease.

The women were followed for 7 years and outcomes included in-hospital arrhythmias, eclampsia or preeclampsia, congestive HF, length of stay, preterm labor, maternal readmission at 1 year and in-hospital mortality. Fetal outcomes included growth restriction, distress and disease.

Risks elevated but rare

Women with congenital heart disease were more likely to undergo cesarean delivery vs. women without (39.3% vs. 32%; P < .001).

Incidents of cardiac complications in hospital were rare, with fewer than 10 women each having congestive HF, ventricular arrhythmias, atrial arrhythmias or maternal mortality.

Compared with no congenital heart disease, noncomplex congenital heart disease was associated with greater risk for congestive HF (OR = 9.7; 95% CI, 4.7-20), atrial arrhythmias (OR = 8.2; 95% CI, 3-22.7) and fetal growth restriction (OR = 1.6; 95% CI, 1.3-2).

Complex congenital heart disease was also associated with greater risk for congestive HF (OR = 56.6; 95% CI, 17.6-182.5), atrial arrhythmias (OR = 31.8; 95% CI, 4.3-236.3) and fetal growth restriction (OR = 3.5; 95% CI, 2.1-6.1) vs. no congenital heart disease. In this group, there was also an increased risk for serious ventricular arrhythmias (OR = 31.8; 95% CI, 4.3-236.3) and maternal in-hospital mortality (OR = 79.1; 95% CI, 23.9-261.8).

Women with any kind of congenital heart disease had a greater risk for hospital readmission (OR = 3.6; 95% CI, 3.3-4) vs. women with no congenital heart disease.

Where to deliver

“Hayward and colleagues recommend that all pregnant patients with [adult congenital heart disease] deliver in an institution with an [adult congenital heart disease] center,” William R. Davidson Jr., MD, of the Penn State Hershey Heart and Vascular Institute at Pennsylvania State University College of Medicine, wrote in an accompanying editorial. “However, their data suggest that many of these patients may be at sufficiently low risk for [CV] complications that delivery locally is safe and feasible.

“Patients with factors increasing risk above minimum will require an effective team of an [adult congenital heart disease] cardiologist, obstetrician and anesthesiologist who are willing to work collaboratively, communicate clearly, monitor patients appropriately and have a written plan for labor, delivery and postpartum follow-up as recommended in a recent scientific statement,” Davidson wrote. “These patients with more complex disease will no doubt be best served in an [adult congenital heart disease] center.” – by Cassie Homer

Disclosure: The researchers and Davidson report no relevant financial disclosures.

Women with congenital heart disease had more complications during hospitalization for delivery vs. women without a heart defect, although occurrences were uncommon, according to findings published in JAMA Cardiology.

“Owing to improvements in the treatment of congenital heart disease, most patients with [congenital heart disease] now survive to adulthood, and more than 1 million adults are living with [congenital heart disease] in the United States,” Robert M. Hayward, MD, assistant professor at the University of Massachusetts Medical School, and colleagues wrote in the study background. “As patients with congenital heart disease live longer, arrhythmias are an increasing cause of morbidity and mortality. In addition, more women with congenital heart disease are becoming pregnant, and these patients are at increased risk for arrhythmias and congestive HF.”

As a part of the Healthcare Cost and Utilization Project’s California database, women who gave birth from 2005 to 2011 were included in the study. Of the 3.6 million identified deliveries, 3,189 women had noncomplex congenital heart disease and 262 had complex congenital heart disease.

The women were followed for 7 years and outcomes included in-hospital arrhythmias, eclampsia or preeclampsia, congestive HF, length of stay, preterm labor, maternal readmission at 1 year and in-hospital mortality. Fetal outcomes included growth restriction, distress and disease.

Risks elevated but rare

Women with congenital heart disease were more likely to undergo cesarean delivery vs. women without (39.3% vs. 32%; P < .001).

Incidents of cardiac complications in hospital were rare, with fewer than 10 women each having congestive HF, ventricular arrhythmias, atrial arrhythmias or maternal mortality.

Compared with no congenital heart disease, noncomplex congenital heart disease was associated with greater risk for congestive HF (OR = 9.7; 95% CI, 4.7-20), atrial arrhythmias (OR = 8.2; 95% CI, 3-22.7) and fetal growth restriction (OR = 1.6; 95% CI, 1.3-2).

Complex congenital heart disease was also associated with greater risk for congestive HF (OR = 56.6; 95% CI, 17.6-182.5), atrial arrhythmias (OR = 31.8; 95% CI, 4.3-236.3) and fetal growth restriction (OR = 3.5; 95% CI, 2.1-6.1) vs. no congenital heart disease. In this group, there was also an increased risk for serious ventricular arrhythmias (OR = 31.8; 95% CI, 4.3-236.3) and maternal in-hospital mortality (OR = 79.1; 95% CI, 23.9-261.8).

Women with any kind of congenital heart disease had a greater risk for hospital readmission (OR = 3.6; 95% CI, 3.3-4) vs. women with no congenital heart disease.

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Where to deliver

“Hayward and colleagues recommend that all pregnant patients with [adult congenital heart disease] deliver in an institution with an [adult congenital heart disease] center,” William R. Davidson Jr., MD, of the Penn State Hershey Heart and Vascular Institute at Pennsylvania State University College of Medicine, wrote in an accompanying editorial. “However, their data suggest that many of these patients may be at sufficiently low risk for [CV] complications that delivery locally is safe and feasible.

“Patients with factors increasing risk above minimum will require an effective team of an [adult congenital heart disease] cardiologist, obstetrician and anesthesiologist who are willing to work collaboratively, communicate clearly, monitor patients appropriately and have a written plan for labor, delivery and postpartum follow-up as recommended in a recent scientific statement,” Davidson wrote. “These patients with more complex disease will no doubt be best served in an [adult congenital heart disease] center.” – by Cassie Homer

Disclosure: The researchers and Davidson report no relevant financial disclosures.