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Original research article
Birth weight in pregnancies complicated by maternal heart disease
  1. Matthew Cauldwell1,
  2. Philip Steer1,
  3. Monique Sterrenburg2,
  4. Suzanne Wallace3,
  5. Gemma Malin3,
  6. Gemma Ulivi4,
  7. Thomas Everett4,
  8. Adam Daniel Jakes5,
  9. Catherine E G Head6,
  10. Aarthi R Mohan7,
  11. Sophie Haynes7,
  12. Margaret Simpson8,
  13. Janet Brennand9,
  14. Mark R Johnson1
  1. 1 Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
  2. 2 Department of Human Development and Health, Princess Anne Hospital, Southampton, UK
  3. 3 Department of Obstetrics, Nottingham City Hospital, Nottingham, UK
  4. 4 Department of Obstetrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  5. 5 Department of Obstetrics, Guy’s and Saint Thomas’ NHS Foundation Trust, London, UK
  6. 6 Adult Congenital Heart Disease Service, St Thomas’ Hospital, London, UK
  7. 7 Department of Obstetrics, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  8. 8 Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Glasgow, UK
  9. 9 Department of Obstetrics, Queen Elizabeth University Hospital, Glasgow, UK
  1. Correspondence to Dr Matthew Cauldwell, Academic Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London SW10 9NH, UK; mrc100{at}ic.ac.uk

Abstract

Objective To assess median and percentile birthweight distribution in women with various groups of heart disease relative to a contemporaneous comparison group.

Methods Data on birth weight and gestational age were collected from 1321 pregnancies ≥24 weeks’ gestation in 1053 women with heart disease from seven UK maternity units. Women were assigned to one of 16 groups according to their cardiac lesion. In units where it was possible, data on two births, one delivering before and one after index cases, were collected, giving 2307 comparators. Birthweight percentiles (corrected for gestational age, sex and parity) were calculated using Aberdeen norms. We assessed the association of birth weight with cardiac lesion, maternal hypoxaemia (saturations <90%), systemic ventricular function and beta-blockers.

Results 1321 pregnancies in women with heart disease and 2307 comparators were studied. Almost all groups with heart disease had lower median and percentile birth weights than comparators, significantly in 10 groups, the biggest effect seen in women with Fontan circulation, pulmonary hypertension, prosthetic heart valves, systemic right ventricle, Marfan syndrome, repaired tetralogy of Fallot and cardiomyopathy (in that order). In 307 pregnancies, women took beta-blockers; median birth weight adjusted for maternal age, parity and the effect of the cardiac lesion was 3116.7 g (IQR 790.4) when beta-blockers were used and 3354.3 g (IQR 634.1) when they were not (p<0.001). 17 women had saturations <90%, and median birth weight was significantly lower, 3105.4 g (IQR 1288.9) versus 3387.7 g (IQR 729.8) (p=0.006).

Conclusion Our findings identify specific groups of women with heart disease at risk of having a small baby.

  • pregnancy
  • congenital heart disease

https://doi.org/10.1136/heartjnl-2018-313551

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    Footnotes

    • Contributors MC conceived the idea for the study and designed the data collection and collated data from C&W. MS, SW, GM, GU, TE, ADJ, ARM, SH, MS and JB were responsible for data collection at each of the other sites. MC and PS analysed the data. MC wrote the first draft revised by MRJ and PS. All authors reviewed and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

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