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Maternal cardiovascular events during childbirth among women with congenital heart disease
  1. Alexander R Opotowsky1,2,
  2. Omar K Siddiqi3,4,
  3. Benjamin D'Souza3,
  4. Gary D Webb5,
  5. Susan M Fernandes1,2,
  6. Michael J Landzberg1,2
  1. 1Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA
  2. 2Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
  4. 4Division of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5Cincinnati Adolescent and Adult Congenital Heart Disease Program, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  1. Correspondence to Dr Alexander R Opotowsky, Boston Adult Congenital Heart Program, Children's Hospital Boston, Department of Cardiology, 300 Longwood Avenue, Bader 209, Boston, MA 02115, USA; alexander.opotowsky{at}childrens.harvard.edu

Abstract

Objectives To define the epidemiology of adverse cardiovascular events among women with congenital heart disease (CHD) hospitalised for childbirth in the USA.

Design and setting The 1998–2007 Nationwide Inpatient Sample, an administrative dataset representative of overall US hospital admissions, was used to identify hospitalisations for delivery.

Main outcome measures 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 comorbidites, 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.

  • Congenital heart disease
  • adults
  • epidemiology
  • pregnancy
  • cesarean section

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Footnotes

  • Preliminary data were presented in abstract form at the American Heart Association Scientific Sessions, 2009.

  • Competing interests None.

  • Ethics approval The Institutional Review Board of the Hospital of University of Pennsylvania granted an exemption

  • Provenance and peer review Not commissioned; externally peer reviewed.

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