Low complication rate among pregnant women with congenital heart disease

CHICAGO — Pregnant women with congenital heart disease had a low rate of congestive HF and arrhythmias during hospitalization and no greater risk for in-hospital mortality and cardiac arrest than women without congenital heart disease, according to data presented at the American Heart Association Scientific Sessions.

“The risk for complications is not as high as expected in women with congenital heart disease,” Robert M. Hayward, MD, a cardiac electrophysiology fellow at the University of California, San Francisco, said during a presentation.

The study cohort included more than 2.7 million women who had vaginal or cesarean deliveries in California from 2005 to 2011. Of those patients, 3,218 had noncomplex congenital heart disease and 248 had complex congenital heart disease.

According to results presented, 8.1% of women with complex congenital heart disease had a history of congestive HF compared with 2.6% of women with noncomplex congenital heart disease and 0.08% of women without congenital heart disease.

Forty-seven percent of women with complex congenital heart disease had a cesarean delivery compared with 40% of women with noncomplex congenital heart disease and 33% of women without congenital heart disease.

Researchers reported women with complex congenital heart disease had a mean length of hospital stay of 5 days compared with 3.4 days for women with noncomplex congenital heart disease and 2.5 days for women without congenital heart disease.
“While we don’t know why these women have longer hospital stays, it’s possible their doctors are keeping them admitted for extra observation,” Hayward said.

Up to 30 days postpartum, 4% of women with congenital heart disease were readmitted to the hospital compared with 1% of women without congenital heart disease.

In other results, maternal in-hospital mortality was not significantly higher in the women with complex congenital heart disease (0.4%) compared with women with noncomplex congenital heart disease (0.09%) and women without congenital heart disease (0.008%). Incident congestive HF (0.81% vs. 0.31% vs. 0.01%, respectively), sustained ventricular tachycardia (SVT), including atrial fibrillation, atrial flutter or paroxysmal SVT (0.4% vs. 0.09% vs. 0.01%) and inpatient cardiac arrest (0% vs. 0.06% vs. 0.01%) were uncommon in all pregnant women studied.

The study does not confront the maternal health of women with congenital heart disease nor fetal health during pregnancy or after delivery, according to Hayward.

“We didn’t capture women prior to delivery, so this analysis is not able to say anything about women who chose not to pursue pregnancy or who did not carry pregnancy to term,” Hayward said. “There’s reason to think those women may be a particularly high risk for arrhythmias and for cardiac complications around the time of delivery.”

For more information:

Hayward RM. Abstract #19082. Presented at: American Heart Association Scientific Sessions; Nov. 15-19, 2014; Chicago.

Disclosure: Hayward reports no relevant financial disclosures.