In developed world, women with congenital heart disease typically give birth safely
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In a study published in the European Heart Journal, researchers found low maternal mortality among pregnant women with congenital heart disease in highly developed health care systems.
“The most important finding from our study is that many women born with a congenital heart defect are able to get through pregnancy and give birth safely,” Astrid Elisabeth Lammers, MD, a consultant in pediatric cardiology in the department for adults with congenital heart disease at the University Hospital Münster, Germany, said in a press release. “This is important because only a few decades ago many women would not even have reached adult age themselves. It is very encouraging to see that such a large number of mothers with a congenital heart defect can give birth to healthy children.”
The population-based study utilized administrative data from one of the largest German health insurance companies to identify all pregnancies occurring among women with congenital heart disease from 2005 to 2018. Researchers also identified an age-matched cohort without congenital heart disease as the control group to compare and analyze the associations between adult congenital heart disease and maternal or neonatal outcomes.
Low maternal complication rate
There were 7,512 pregnancies identified in 4,015 women with congenital heart disease and an age-matched cohort of 11,225 pregnancies in 6,502 women.
Women with congenital heart disease had more cesarean deliveries compared with the control group (40.5% vs. 31.5%; P < .001) with no excess mortality observed. Though researchers observed a low maternal complication rate among women with congenital heart disease, these women showed higher rates for stroke, HF and cardiac arrythmias throughout their pregnancies (P < .001 for all).
Total neonatal mortality was low but higher among women with congenital heart disease (0.83% vs. 0.22%; P = .001). In addition, neonates born to women with congenital heart disease were more likely to have low and extremely low birth weights or extreme immaturity (P < .001) compared with those born to women without congenital heart disease. These neonates also more often required resuscitation and mechanical ventilation compared with neonates in the control group (P < .001 for both). Congenital heart disease recurrence in infants born to women with congenital heart disease was 6.1 times higher compared with the control group (P < .0001).
In a multivariate logistic regression analysis, significant predictors of adverse neonatal outcomes included maternal defect complexity, arterial hypertension, HF, prior fertility treatment and anticoagulation with vitamin K antagonists (P < .05 for all).
Counseling important
“Our findings should help to inform mothers-to-be with congenital heart disease what to expect in terms of neonatal complications and to direct them to appropriate care providers if they wish to start a family,” Lammers said. “Counseling is a very important part of the care of every woman with a congenital heart defect and should start at an early age.”
In a related editorial, Jolien W. Roos-Hesselink, MD, and Karishma P. Ramlakhan, both from the department of cardiology at Erasmus University Medical Center Rotterdam, The Netherlands, noted that the differences shown in this study highlight how health care systems and environments of women greatly impact pregnancy outcomes and demonstrate the importance of improving these outcomes for women worldwide.
“The study shows that a good health care system, a multidisciplinary approach and decisive pre-pregnancy counseling are effective in achieving safe pregnancies,” Roos-Hesselink and Ramlakhan wrote.
Reference:
Roos-Hesselink J, et al. Eur Heart J. 2021;doi:10.1093/eurheartj/ehab692.
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