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April 6, 2021Journal of the American Heart AssociationOpen Access

Maternal and Neonatal Outcomes of Pregnancies in Women With Congenital Heart Disease: A Meta‐Analysis

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Key result

Maternal CHD severity correlates with higher neonatal morbidity and up to 3.5% mortality.

Why the study?

As more women with congenital heart disease survive to reproductive age, this study aimed to evaluate modern-era maternal and neonatal pregnancy outcomes.

Does the severity of maternal congenital heart disease impact the risk of maternal and neonatal mortality and morbidity during pregnancy?

Population

32 studies of pregnancies in women with CHD

Comparison

Mild vs moderate vs severe CHD lesions

Design

Meta-analysis

Authors

IHIsabel HardeeLWLydia WrightCMCourtney McCracken

Discussion

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Overview

Supports lesion-stratified counseling in maternal CHD; extends observational meta-analyses but leaves prospective validation open.

Structured PICO

Does the severity of maternal congenital heart disease impact the risk of maternal and neonatal mortality and morbidity during pregnancy?

P
Population
2,770 women with congenital heart disease (CHD) representing 3,491 pregnancies, average age 21-30 years. Multinational (25 non-US, 8 US, 1 mixed). CHD lesions categorized as mild (atrial septal defect, patent ductus arteriosus, ventricular septal defect), moderate (coarctation of the aorta, Ebstein's anomaly, pulmonic stenosis, tetralogy of Fallot), and severe (double-outlet right ventricle, Fontan palliation, pulmonic atresia, transposition of the great arteries, Eisenmenger's syndrome).
I
Intervention
Pregnancy in the context of maternal congenital heart disease (analyzed by lesion severity: mild, moderate, severe).
C
Comparator
Comparison across maternal congenital heart disease severity groups (mild vs. moderate vs. severe).
O
Outcome
Maternal mortality (variably defined from within pregnancy to within the first year after delivery) or fetal mortality (infant demise within the first 28 days of life).hard clinical

While pregnancy in women with congenital heart disease is generally successful, the risk of maternal morbidity and neonatal mortality increases significantly with the severity of the maternal cardiac lesion.

Limitations

  • Too few maternal deaths to pool data
  • Substantial heterogeneity in pooled rates of arrhythmia, heart failure, and hypertensive diseases
  • Publication bias for heart failure in severe CHD and postpartum hemorrhage

Cite This Study

Hardee et al. (2021) studied this question. Neonatal mortality rates were 1%, 3.1%, and 3.5% for mild, moderate, and severe CHD lesions, respectively, with increased morbidity correlated to lesion severity.

synapsesocial.com/papers/69696f28ffe1ecee9edd5e8dhttps://doi.org/10.1161/jaha.120.017834
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