Severity of congenital heart disease tied to maternal, neonatal outcomes
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In a meta-analysis, neonatal mortality and maternal and neonatal morbidity rose as the severity of maternal congenital heart disease increased.
“This meta-analysis established a relationship between congenital heart disease severity and adverse pregnancy outcomes. However, more lesion-specific research will be needed to counsel women on their individual risk,” Isabel Hardee, MD, from the department of pediatrics at the University of Colorado School of Medicine, Denver, told Healio. “Women with congenital heart disease, and particularly those with severe lesions, should receive lesion-specific preconception and intrapartum counseling from tertiary centers with reproductive programs.”
The meta-analysis included 32 peer-reviewed studies published from 2007 to June 2019 that reported on maternal or fetal mortality and provided data from congenital heart disease lesions. Researchers categorized lesions as mild, moderate or severe.
Mild lesions were defined as atrial septal defect, patent ductus arteriosus and ventricular septal defect; moderate lesions were defined as coarctation of the aorta, Ebstein anomaly, pulmonic stenosis and tetralogy of Fallot; and severe lesions were defined as double-outlet right ventricle, history of a Fontan palliation procedure, pulmonic atresia, transposition of the great arteries and Eisenmenger syndrome.
The analysis included 2,770 women with congenital heart disease who had 3,491 pregnancies. The neonatal mortality rate was 1% for those with mild lesions, 3.1% for those with moderate lesions and 3.5% for those with severe lesions.
The maternal and neonatal morbidity rates among women with congenital heart disease increased as lesion severity increased. As maternal congenital heart disease increased from mild to moderate to severe, cesarean section (22.5%, 30.8% and 52.5%, respectively), preterm birth (5.8%, 13.9% and 50.5%, respectively) and small for gestational age (14.6%, 13.8% and 35.8%, respectively) risk substantially increased.
Too few maternal deaths occurred in all three groups to pool data.
“This study uniquely quantifies the relative risks of pregnancy-related outcomes among women with varying degrees of congenital heart disease severity,” Hardee said in an interview. “We hope the findings will aid practitioners in counseling the thousands of girls with congenital heart disease who now survive to childbearing age.”
For more information:
Isabel Hardee, MD, can be reached at isabel.hardee@childrenscolorado.org.
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