title: Maternal, perinatal, and postneonatal outcomes in women with chronic heart disease in Washington State.
abstract: OBJECTIVE
  To explore the association between the presence of maternal heart disease and maternal, perinatal, and infant outcomes.
  
  
  METHODS
  We conducted a population-based retrospective cohort study using Washington State birth certificates linked with hospital discharge records of mothers noted to have maternal congenital heart disease, ischemic heart disease, heart failure, or pulmonary hypertension. Women who gave birth between 1987 and 2009 (n=2,171) were compared with a sample of mothers without these conditions (n=21,710). We described characteristics of pregnant women with heart disease over time. Logistic regression estimated the association between chronic maternal heart disease and small-for-gestational-age (SGA) neonates as well as perinatal, postneonatal, and maternal death.
  
  
  RESULTS
  The proportion of births to women with reported heart disease increased 224% between the 1987 and 1994 and 2002 and 2009 calendar periods. Chronic maternal heart disease was associated with increased risk of SGA (62 additional SGA newborns per 1,000 births, 95% confidence interval [CI] 46-78; P<.001), perinatal death (14 additional deaths per 1,000 births, 95% CI 8-20; P<.001), postneonatal death (5 additional deaths per 1,000 births, 95% CI 2-9; P<.001), and maternal death (5 additional deaths per 1,000 births, 95% CI 2-9; P<.001).
  
  
  CONCLUSIONS
  The presence of chronic maternal heart disease is associated with elevated risk for poor maternal, perinatal, and postneonatal outcomes.
authors.affiliation: Department of Obstetrics and Gynecology and Divisions of Pulmonary and Critical Care Medicine and Cardiology, University of Washington Medical Center, Seattle, Washington 98195-6522, USA. learyp@uw.edu
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Leary
authors.forename: Sarah E S
authors.initials: SE
authors.lastname: Leary
authors.forename: Karen K
authors.initials: KK
authors.lastname: Stout
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Easterling
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D046689:Fetal Mortality; D006331:Heart Diseases / Q000151:congenital / Q000453:epidemiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000151:congenital / Q000453:epidemiology; D007226:Infant Mortality; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008428:Maternal Mortality; D008429:Maternal Welfare; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D014861:Washington / Q000453:epidemiology; D055815:Young Adult