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(Circulation. 2006;113:517-524.)
© 2006 American Heart Association, Inc.

Cardiovascular Disease in Women

Pregnancy Outcomes in Women With Congenital Heart Disease

Paul Khairy, MD, PhD; David W. Ouyang, MD; Susan M. Fernandes, MPH, PA-C; Aviva Lee-Parritz, MD; Katherine E. Economy, MD; Michael J. Landzberg, MD

From the Boston Adult Congenital Heart Service, Brigham and Women’s Hospital and Children’s Hospital Boston (P.K., S.M.F., M.J.L.), and Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School (D.W.O., A.L.-P., K.E.E.), Boston, Mass.

Correspondence to Dr Paul Khairy, Electrophysiology and Adult Congenital Heart Disease, Montreal Heart Institute, 5000 Bélanger St, Montreal, Quebec, Canada H1T 1C8. E-mail paul.khairy{at}cardio.CHBoston.org

Received September 19, 2005; revision received December 7, 2005; accepted December 9, 2005.

Background— Pregnant women with congenital heart disease are at increased risk for cardiac and neonatal complications, yet risk factors for adverse outcomes are not fully defined.

Methods and Results— Between January 1998 and September 2004, 90 pregnancies at age 27.7±6.1 years were followed in 53 women with congenital heart disease. Spontaneous abortions occurred in 11 pregnancies at 10.8±3.7 weeks, and 7 underwent elective pregnancy termination. There were no maternal deaths. Primary maternal cardiac events complicated 19.4% of ongoing pregnancies, with pulmonary edema in 16.7% and sustained arrhythmias in 2.8%. Univariate risk factors included prior history of heart failure (odds ratio [OR], 15.5), NYHA functional class 2 (OR, 5.4), and decreased subpulmonary ventricular ejection fraction (OR, 7.7). Independent predictors were decreased subpulmonary ventricular ejection fraction and/or severe pulmonary regurgitation (OR, 9.0) and smoking history (OR, 27.2). Adverse neonatal outcomes occurred in 27.8% of ongoing pregnancies and included preterm delivery (20.8%), small for gestational age (8.3%), respiratory distress syndrome (8.3%), intraventricular hemorrhage (1.4%), intrauterine fetal demise (2.8%), and neonatal death (1.4%). A subaortic ventricular outflow tract gradient >30 mm Hg independently predicted an adverse neonatal outcome (OR, 7.5). Cardiac risk assessment was improved by including decreased subpulmonary ventricular systolic function and/or severe pulmonary regurgitation (OR, 10.3) in a previously proposed risk index developed in pregnant women with acquired and congenital heart disease.

Conclusions— Maternal cardiac and neonatal complication rates are considerable in pregnant women with congenital heart disease. Patients with impaired subpulmonary ventricular systolic function and/or severe pulmonary regurgitation are at increased risk for adverse cardiac outcomes.

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Circulation 2006 113: 463. [Full Text]

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