title: Maternal cardiovascular events during childbirth among women with congenital heart disease.
abstract: OBJECTIVE
  To define the epidemiology of adverse cardiovascular events among women with congenital heart disease (CHD) hospitalised for childbirth in the USA.
  
  
  METHODS
  The 1998-2007 Nationwide Inpatient Sample, an administrative dataset representative of overall US hospital admissions, was used to identify hospitalisations for delivery.
  
  
  METHODS
  Logistic regression was used to estimate ORs for cardiovascular outcomes (arrhythmia, heart failure, cerebrovascular accident, embolism, death or a combined outcome) for women with and without CHD. Covariates included age, number of medical comorbidities, pulmonary hypertension, hospital teaching status, insurance status and method of delivery.
  
  
  RESULTS
  Annual deliveries for women with CHD increased 34.9% from 1998 to 2007 compared with an increase of 21.3% in the general population. Women with CHD were more likely to sustain a cardiovascular event (4042/100,000 vs 278/100,000 deliveries, univariate OR 15.1, 95% CI 13.1 to 17.4, multivariable OR 8.4, 95% CI 7.0 to 10.0). Arrhythmia, the most common cardiovascular event, was more frequent among women with CHD (2637/100,000 vs 210/100,000, univariate OR 12.9, 95% CI 10.9 to 15.3, multivariable OR 8.3, 95% CI 6.7 to 10.1). Death occurred in 150/100,000 patients with CHD compared with 8.2/100,000 patients without CHD (multivariable OR 6.7, 95% CI 2.9 to 15.4). Complex CHD was associated with greater odds of having an adverse cardiovascular event than simple CHD (8158/100,000 vs 3166/100,000, multivariable OR 2.0, 95% CI 1.4 to 3.0).
  
  
  CONCLUSIONS
  Maternal CHD is associated with a markedly increased risk of adverse cardiovascular events and death during admission for delivery.
authors: Boston Adult Congenital Heart Program, Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA. alexander.opotowsky@childrens.harvard.edu
authors: Alexander R
authors: AR
authors: Opotowsky
authors: Omar K
authors: OK
authors: Siddiqi
authors: Benjamin
authors: B
authors: D'Souza
authors: Gary D
authors: GD
authors: Webb
authors: Susan M
authors: SM
authors: Fernandes
authors: Michael J
authors: MJ
authors: Landzberg
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology*; D006801:Humans; D036801:Parturition; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors