Abstract 1773: Outcomes of Childbirth Among Women With Congenital Heart Disease in the United States
Introduction: A growing number of patients with congenital heart disease (CHD) are reaching reproductive age, and CHD is now more common than acquired cardiac disease among pregnant women.
Methods: We used the 1998–2006 Nationwide Inpatient Sample, a large nationally representative hospital discharge database, to assess national trends in pregnancies, focusing on childbirth, among patients with CHD. Patients were identified using ICD-9 procedure and diagnosis codes reflective of delivery and CHD. The primary outcome of interest was a combined variable including death, heart failure, arrhythmia, stroke/TIA, embolic events, and other cardiovascular events related to pregnancy.
Results: There were approximately 37,767,444 deliveries in the US 1998 –2006, and maternal CHD was present in 71/100,000 deliveries. The number of CHD deliveries increased 26% over the study period, as compared with 11% in the general population. Patients with CHD were slightly younger (27.2 v. 27.4 years old), more likely to have ≥1 medical comorbidity (19.6% v 11.4%), and more likely to deliver by Cesarean section (CS). In patients without CHD the combined outcome occurred in 285/100,000 deliveries, as compared with 3,937/100,000 for patients with CHD (see table⇓). In a multivariate model (adjusting for age, pulmonary hypertension, # of comorbidities, and method of delivery), the combined cardiovascular outcome was still more likely for women with CHD (OR 8.4, 95% CI 7.0 –10.2). CS was associated with increased risk of the combined outcome (OR 1.5, 95% CI 1.1–2.0) in CHD patients. Complex CHD, including simple lesions with concomitant pulmonary hypertension, carried a higher risk of cardiovascular complications than simple CHD (6.3 v. 3.4%, OR 1.9, 95% CI 1.4 –2.6).
Conclusion: Pregnant women with CHD are at markedly higher risk of death and cardiovascular complications during admission for delivery.