Maternal cardiac disease and perinatal outcomes in a single tertiary care center

• Published in: The journal of maternal-fetal & neonatal medicine Vol. 36; no. 2; p. 2223336
• Main Authors: Gonzalez, Juan M., Harris, Ian, Jimenez Ramirez, Norma, Myers, Dana, Killion, Molly, Thiet, Mari-Paule, Bianco, Katherine
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 15.12.2023
• Subjects: cardiovascular disease; Child; Congenital heart disease; Female; Fetal Growth Retardation - epidemiology; Heart Defects, Congenital - epidemiology; Humans; Infant, Newborn; IUGR; Pregnancy; Pregnancy Outcome - epidemiology; Premature Birth - epidemiology; PTB; Retrospective Studies; Tertiary Care Centers; cardiovascular disease; Congenital heart disease; IUGR; pregnancy; PTB
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2023.2223336

Maternal mortality in the U.S. has increased, with a substantial contribution from maternal cardiac disease. As a result of improved childhood survival, more women with congenital heart disease are reaching reproductive age leading to a growing high-risk obstetric population. We sought to determine the obstetrical and neonatal outcomes of women with maternal cardiac disease, including acquired cardiovascular disease and congenital heart disease. We studied a retrospective cohort study of women that delivered from 2008 to 2013 (N = 9026). Singleton pregnancies without preexisting conditions were established as the unexposed group for this study. Maternal and neonatal outcomes were compared between the unexposed group (N = 7277) and women exposed to maternal (acquired or congenital) cardiac disease (N = 139) as well as only congenital heart disease (N = 85). Statistical comparisons used univariate/multivariable logistic and linear regression analysis controlling for confounders with p < .05 and 95% confidence intervals indicating statistical significance. Pregnancies complicated by maternal cardiac disease were associated with increased odds of preterm birth (<34 weeks, <37 weeks), intrauterine growth restriction (IUGR), need for assisted vaginal delivery, maternal ICU admission, and prolonged maternal hospitalization (>7 d). Neonatal outcomes including small for gestational age and Apgar score <7 at 5 min were increased in the pregnancies complicated by maternal cardiac disease. When pregnancies complicated by congenital heart disease were analyzed as a sub-group of the cohort, the results were similar. There were increased odds of preterm birth (<37 weeks), early-term delivery, need for assisted vaginal delivery, and prolonged hospitalization. Neonatal outcomes were only significant for small for gestational age. We observed that in a select cohort of pregnancies complicated by maternal cardiac diseases (acquired or congenital), there were significant increases of adverse perinatal outcomes. Therefore, a multidisciplinary approach including maternal-fetal medicine specialists, cardiologists, obstetric anesthesia, and dedicated ancillary support is imperative for optimal care of this high-risk obstetrics population.