title: Cardiovascular and Neonatal Outcomes in Pregnant Women With High-Risk Congenital Heart Disease.
abstract: Congenital heart disease (CHD) increases the risk of adverse maternal and neonatal outcomes. However, previous studies have included mainly women with low-risk features. A single-center, retrospective analysis of pregnant women with CHD was performed. Inclusion criteria were the following high-risk congenital lesions and co-morbidities: maternal cyanosis; New York Heart Association (NHYA) functional class >II; severe ventricular dysfunction; maternal arrhythmia, single ventricle (SV) physiology, severe left-sided heart obstruction and severe pulmonary arterial hypertension. Multivariate analyses for predictors of adverse maternal cardiovascular and neonatal outcomes were performed. Forty-three women reported 61 pregnancies. There were no maternal or neonatal deaths. Maternal cardiac (31%) and neonatal (54%) complications were frequent. The most frequent cardiac events were pulmonary edema, arrhythmia, and reduced NYHA class. Previous arrhythmia conferred a 12-fold increase in the odds of experiencing at least one major cardiac complication. Maternal SV physiology was an independent risk factor for low birth weight, risk of neonatal intensive care unit admission and lower gestational age. Maternal cyanosis and severe pulmonary arterial hypertension also predicted adverse neonatal outcomes. In conclusion, mothers without antepartum arrhythmia or functional incapacity are unlikely to experience arrhythmias or a decrease in NYHA class during pregnancy. In addition, SV physiology is a robust predictor of neonatal complications. Antepartum counseling and assessment of maternal fitness are crucial for the woman with CHD.
authors.affiliation: Division of Cardiology, Department of Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance, California. Electronic address: ppillutla@labiomed.org.
authors.forename: Priya
authors.initials: P
authors.lastname: Pillutla
authors.affiliation: Department of Obstetrics and Gynecology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California.
authors.forename: Tina
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Department of Biostatics, University of California Los Angeles, Los Angeles, California.
authors.forename: Daniela
authors.initials: D
authors.lastname: Markovic
authors.affiliation: Ahmanson/UCLA ACHD Center Lecturer, University of California Los Angeles, School of Nursing, Los Angeles, California.
authors.forename: Mary
authors.initials: M
authors.lastname: Canobbio
authors.affiliation: Department of Obstetrics and Gynecology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Koos
authors.affiliation: Division of Cardiology, Department of Medicine, Ahmanson/University of California, Los Angeles Adult Congenital Heart Disease Center, Los Angeles, California.
authors.forename: Jamil A
authors.initials: JA
authors.lastname: Aboulhosn
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors