Pregnancy correlates with increased long-term cardiac outcomes in congenital heart disease

Among women with congenital heart disease, pregnancy was associated with an increase in adverse long-term cardiac outcomes, according to a retrospective longitudinal cohort study.

Since patients with congenital heart disease (CHD) are living longer due to improved early life interventions and considering pregnancy, Shannon L. Son, MD, a maternal-fetal medicine fellow at the University of Utah, and colleagues evaluated pregnancy’s association with long-term cardiovascular health.

“Data on long-term cardiac outcomes after pregnancy are unknown for most lesion types,” Son and colleagues wrote in the American Journal of Obstetrics & Gynecology. “This limits health care practitioners’ ability to thoroughly counsel patients considering pregnancy in the setting of congenital heart disease.”

The researchers analyzed data from 711 women who were treated at two adult CHD centers between 2014 and 2019. The participants were followed from 15 years of age or the time they entered the health care system until the end of the study, death or the time they left the health care system, the researchers wrote.

The researchers compared the primary outcome — a composite adverse cardiac outcome that included death, stroke, heart failure, unanticipated cardiac surgery or requirement of a catheterized procedure — between parous (at least one delivery beyond 20 weeks gestation) and nulliparous women.

Among 209 parous women, aortic stenosis, bicuspid aortic valve, dilated ascending aorta/aortic root, aortic regurgitation and pulmonary insufficiency were more common. Dextro-transposition of the great arteries, Turner syndrome, hypoplastic right heart, left superior vena cava and other cardiac issues were more common among the 502 nulliparous participants.

In a multivariable analysis, pregnancy was associated with the composite adverse cardiac outcome (36.4% vs. 26.1%; HR = 1.83; 95% CI, 1.25-2.66), and parous women were more likely to have unanticipated cardiac surgery (28.2% vs. 18.1%; P = .003). There were no statistically significant differences regarding the other individual components of the primary outcome between parous and nulliparous participants, the researchers said.

Adjusting for cardiac lesion type, the association between pregnancy and the primary outcome was similar (HR = 1.61; 95% CI, 1.1-2.36).

“These data may inform counseling of women with CHD considering pregnancy,” Son and colleagues wrote.