June 08, 2020
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Congenital heart defects may confer cardiac, obstetric complications during pregnancy

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Women with congenital heart defects were more likely to experience cardiac and obstetric complications during pregnancy compared with women without heart defects, researchers reported.

Additionally, 4% of these women were prescribed potentially teratogenic or fetotoxic medications and only half underwent a guideline-recommended comprehensive echocardiogram, according to findings published in Circulation: Cardiovascular Quality and Outcomes.

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Researchers assessed U.S. health care claims data from 2007 to 2014 of women aged 15 to 44 years with (n = 2,056) and without (n = 1,374,982) congenital heart defects and private insurance. For this analysis, congenital heart defects were defined as at least one inpatient code or at least two outpatient codes more than 30 days apart, documented outside of pregnancy and categorized as severe or not severe.

Investigators found that women with congenital heart defects experienced a higher prevalence of adverse obstetric conditions (adjusted prevalence ratio [aPR] = 1.3; 95% CI, 1.2-1.4), cardiac conditions (aPR = 10.2; 95% CI, 9.1-11.4), stillbirth (aPR = 1.6; 95% CI, 1.1-2.4) preterm delivery (aPR = 1.6; 95% CI, 1.4-1.8) and adverse conditions overall (aPR = 1.9; 95% CI, 1.7-2.1) compared with women without defects.

Moreover, from the women’s last menstrual period to 90 days postpartum, 56% of patients with congenital heart defects underwent comprehensive echocardiograms during pregnancy in accordance with the American Heart Association recommended guidelines.

In addition, approximately 4% of women with congenital heart defects filled at least one potentially teratogenic or fetotoxic cardiac-related prescription.

“We found women with congenital heart defects (any, severe only and nonsevere only) had higher prevalence of adverse pregnancy outcomes and conditions than women without congenital heart defects, yet only half received recommended comprehensive echocardiograms during pregnancy or up to 90 days postpartum,” Karrie F. Downing, MPH, of the division of congenital and developmental disorders at the CDC, and colleagues wrote. “AHA/American College of Cardiology and American College of Obstetrics and Gynecology recommendations to assess cardiac health, including performing echocardiograms and reviewing medications for benefits and risks, in pregnant women with congenital heart defects may lead to early identification, prevention, or treatment of adverse conditions and improved pregnancy outcomes.”

In other findings, women with severe congenital heart defects experienced more adverse conditions overall (aPR = 1.5; 95% CI, 1.2-1.9) compared with women with nonsevere defects.

“This is the first analysis, to our knowledge, examining receipt of AHA/ACC-recommended cardiac evaluations and filled prescriptions for potentially teratogenic or fetotoxic cardiac-related medications during pregnancy,” the researchers wrote.