title: Effect of maternal heart disease on fetal growth.
abstract: OBJECTIVE
  To estimate the effect of maternal heart disease on fetal growth and neonatal outcomes.
  
  
  METHODS
  A retrospective cohort study of all women with congenital and acquired heart disease admitted at Chelsea and Westminster Hospital between 1994 and 2010 was performed. The women who delivered immediately before and immediately after each index pregnancy were used as controls. Data were obtained from medical and obstetric notes. Birth weight percentiles were calculated using a customized birth weight percentile program, and neonatal complications (preterm birth, perinatal mortality, and recurrence of congenital heart disease) were noted.
  
  
  RESULTS
  Median birth weight percentile was significantly lower in the heart disease group (31) compared with the control group (49;P.001 Mann-Whitney U test [corrected].The rate of neonatal complications was significantly higher in the heart disease group (34% compared with 15%). Preterm birth occurred in 42 (13%) pregnancies, of which 67% were iatrogenic. Eighty-one (25%) newborns in the heart disease group were small for gestational age, and there were four stillbirths and four neonatal deaths (perinatal mortality rate 20 per 1,000).
  
  
  CONCLUSIONS
  This cohort study suggests a significant reduction in fetal growth rates associated with maternal heart disease, which is also associated with preterm delivery and reduced birth weight. The presence of maternal cyanosis and a reduced cardiac output are the most significant predictors.
  
  
  METHODS
  II.
authors.affiliation: From the Academic Department of Obstetrics and Gynaecology, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom; Adult Congenital Heart Centre, National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom; and Chelsea and Westminster Healthcare NHS Foundation Trust, London, United Kingdom.
authors.forename: Emily
authors.initials: E
authors.lastname: Gelson
authors.forename: Ruth
authors.initials: R
authors.lastname: Curry
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
authors.forename: Lorna
authors.initials: L
authors.lastname: Swan
authors.forename: Martin
authors.initials: M
authors.lastname: Lupton
authors.forename: Philip
authors.initials: P
authors.lastname: Steer
authors.forename: Mark
authors.initials: M
authors.lastname: Johnson
mesh_terms: D000328:Adult; D001724:Birth Weight; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005323:Fetal Monitoring / Q000379:methods; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D008429:Maternal Welfare; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D016017:Odds Ratio; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000453:epidemiology; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011295:Prenatal Care / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D006113:United Kingdom