title: Congenital heart disease in pregnancy in a low-income country.
abstract: OBJECTIVE
  To assess maternal and perinatal outcomes among pregnant women with congenital heart disease (CHD) in a low-resource country.
  
  
  METHODS
  A prospective, observational study was conducted at a teaching hospital in Kolkata, India, between January 1, 2008, and December 31, 2010. All pregnant women with CHD were followed up from first prenatal visit to discharge. Both maternal and perinatal outcomes were analyzed.
  
  
  RESULTS
  Of 174 pregnant women with heart disease, 27 (16%) had CHD. Mean age was 23.5±3.6 years. Four (15%) patients were diagnosed with CHD during the index pregnancy. Nine (33%) women had undergone surgical correction before conception. Cesarean delivery was performed in 12 (44%) women. Fifteen (56%) neonates weighed less than 2500 g, and 4 (15%) were born preterm. Mean birth weight was slightly higher in women with corrected heart lesions than in those with uncorrected ones (2593±480 g vs 2294±620 g; P=0.22). Three (11%) neonates died, but no stillbirths occurred. One (4%) woman died after delivery owing to atonic postpartum hemorrhage.
  
  
  CONCLUSIONS
  Delayed diagnosis, lack of treatment, and unplanned pregnancy are major challenges for women with CHD, which need to be addressed to improve maternal and neonatal outcomes in low-resource countries.
authors.affiliation: Department of Obstetrics and Gynecology, ESI Postgraduate Institute of Medical Sciences and Research, Joka, Kolkata, India. Electronic address: njarora@gmail.com.
authors.forename: Nalini
authors.initials: N
authors.lastname: Arora
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Postgraduate Medical Education and Research, Kolkata, India.
authors.forename: Hena
authors.initials: H
authors.lastname: Kausar
authors.affiliation: Department of Obstetrics and Gynecology, Burdwan Medical College, Burdwan, India.
authors.forename: Narayan
authors.initials: N
authors.lastname: Jana
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Postgraduate Medical Education and Research, Kolkata, India.
authors.forename: Sarbeswar
authors.initials: S
authors.lastname: Mandal
authors.affiliation: Department of Cardiology, Institute of Postgraduate Medical Education and Research, Kolkata, India.
authors.forename: Dipankar
authors.initials: D
authors.lastname: Mukherjee
authors.affiliation: Department of Neonatology, Institute of Postgraduate Medical Education and Research, Kolkata, India.
authors.forename: Ranajit
authors.initials: R
authors.lastname: Mukherjee
mesh_terms: D000328:Adult; D001724:Birth Weight; D002585:Cesarean Section; D003906:Developing Countries; D005260:Female; D005865:Gestational Age; D006331:Heart Diseases / Q000150:complications* / Q000151:congenital / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000601:surgery; D006801:Humans; D007194:India; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D066087:Perinatal Death; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D047928:Premature Birth / Q000209:etiology; D011446:Prospective Studies; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery; D055815:Young Adult
keywords: Congenital heart disease; Low-income countries; Maternal mortality; Pregnancy