Abstract 1868: Cardiac Complications Late After Pregnancy in Women With Congenital Heart Disease
BACKGROUND Women with congenital heart disease (CHD) are at risk for pregnancy related complications. However, adverse cardiac events (CE) after pregnancy have not been well defined. Therefore our goal was to examine the frequency and determinants of CE after pregnancy in a large cohort of women with CHD.
METHODS Baseline characteristics and pregnancy outcomes in a consecutive cohort of women with congenital heart disease were prospectively recorded. Late post delivery cardiac outcomes of this cohort (>6 months after delivery) were determined. Primary outcome was defined as maternal CE late (> 6 months after delivery) after pregnancy and included: cardiac death/arrest, pulmonary edema, arrhythmias, or stroke. The need for therapeutic cardiac intervention late (> 6 months after delivery) after pregnancy was considered to be a secondary CE.
RESULTS The outcomes of 405 pregnancies were studied (328 women; median age 29 years, interquartile range [IQR] 25 to 32 years; median follow-up time 2.6 years, IQR 1.4 to 5.2 years). A cardiac complication occurred during 11% (n=46) of pregnancies. During follow up, primary and secondary CE occurred in 12% (n=50) and 15% (n=62) of pregnancies respectively. Six years survival free from primary CE was lower in women with complications during pregnancy compared to those without (72±9 % vs. 82±3%, p=.024). In the multivariate model, subaortic ventricular dysfunction (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.3–5.9; p=.011), subpulmonary ventricular dysfunction and/or pulmonary regurgitation (HR, 3.4; 95% CI, 1.7–7.0; p=.001), left heart obstruction (HR,2.5; 95% CI, 1.2–5.3; p=.022), and CE before or during pregnancy (HR, 2.4; 95% CI, 1.3– 4.6; p=.006) were independent predictors of adverse CE after pregnancy.
CONCLUSIONS Women with CHD are at risk for CE late after pregnancy. Adverse CE during pregnancy have prognostic importance and women who develop pregnancy-related cardiac complications have an increased risk of CE after pregnancy. The risks of adverse CE after pregnancy can be predicted based on antenatal maternal risk factors.