Patients who have unrepaired congenital heart disease (CHD) when they become pregnant are at increased risk for poorer maternal and offspring outcomes compared with patients who have repaired CHD, according to results of a study presented at the American Heart Association (AHA) Scientific Sessions 2022, held from November 5th through 7th, in Chicago, Illinois.
Many patients have unrepaired CHD, especially in developing countries. Having an underlying cardiac condition may complicate pregnancy and offspring outcomes. It remains unclear, however, to what extent unrepaired CHD has on pregnancy and/or offspring outcomes.
To evaluate the effect of CHD on pregnancy and reproduction, an investigator from Shanghai Children’s Medical Center and Shanghai Jiao Tong University School of Medicine in China evaluated data from nationally enrolled pregnancies of women with a CHD (N=2220) from 7 tertiary centers between 1993 and 2019. Maternal and offspring outcomes were evaluated on the basis of repaired or unrepaired CHD status.
A total of 1272 women had unrepaired CHD and shunt lesions were the most common CHD (64.54%).
During pregnancy, 14.94% of the women with unrepaired CHD had heart failure and 1.73% died.
Compared with the repaired CHD cohort, unrepaired CHD was associated with higher incidence rates of adverse events, in which preterm delivery (22.56%) and low birth weight (21.15%) were the most common adverse outcomes.
The significant independent predictors for maternal cardiac events included delayed first antenatal care visit, no strict antenatal supervision, lack of multidisciplinary care management team, New York Heart Association functional class III to IV, elevated brain natriuretic peptide levels, and pulmonary hypertension.
This study is limited by not having sufficient data to perform a CHD-specific subgroup analysis to evaluate whether certain CHDs are associated with differing outcomes.
These data indicate that women who become pregnant with unrepaired CHD may be at increased risk for poor outcomes. Additional study is needed to confirm these findings.
Zhang Q, Fang Z, Shi G, Chen H. Pregnancy outcomes in unrepaired congenital heart disease a multicenter experience from 1272 patients. Presented at: The American Heart Association (AHA) Scientific Sessions 2022; November 5-7, 2022; Chicago, IL. Abstract #VP216.