Abstract 13193: Maternal Arrhythmia, Cyanosis and Single Ventricle Physiology Predict Adverse Outcomes in Pregnant Women With Congenital Heart Disease
Background: Maternal congenital heart disease (CHD) increases the risk of adverse maternal and neonatal outcomes. Prior studies have comprised mainly women with low-risk features. We hypothesized that, in women with high-risk CHD, certain factors portend worse outcomes.
Methods: We performed a single center retrospective analysis of pregnant women with CHD. We selected those with high-risk congenital lesions and comorbidities including: cyanosis (resting oxygen saturation II; severe systemic or subpulmonic ventricular dysfunction; symptomatic sustained arrhythmia, single ventricle physiology (SV) and severe pulmonary arterial hypertension (PAH, systolic pulmonary arterial pressure > 60 mmHg).
Results: Fifty-five women reported 61 pregnancies. There were no maternal or neonatal deaths. None without prior arrhythmia (0/47) suffered a sustained arrhythmia compared with 31% (4/13) of those with prior arrhythmia (p=0.009). Nineteen of 61 (31%) pregnancies had a major maternal cardiac complication; prior arrhythmia conferred a 12-fold increase in this odds (OR 12, CI 2.2-65.3, p=0.004). Half of women (3/6) with preconception NYHA class above 2 had further decline in functional class compared with 11.3% (6/53) among those with normal NYHA class (p=0.04). There were too few subjects with severe ventricular dysfunction (n=2) for statistical analysis. There was no statistically significant association between severe PAH and maternal cardiac outcomes. However, 75% (6/8) of offspring born to women with severe PAH had low birth weight compared with 34% (13/38) in women without (p=0.05). Most neonates born to mothers with cyanosis (6/8, 75%) required NICU admission in comparison to 33% (13/40) in mothers without (p=0.04). Neonates born to mothers with SV had twice the rate of NICU admission (67%, 8/12) compared with those without (31%, 11/36, p=0.04).
Conclusions: Although there were no deaths, cardiac and neonatal complications were frequent in this high-risk cohort. Maternal pre-conception arrhythmia is a strong predictor of both arrhythmias during pregnancy and any major cardiac complication. Neonates born to mothers with SV or maternal cyanosis are at increased risk for NICU admission.
- © 2013 by American Heart Association, Inc.