Fetal and Obstetric Complications Among Pregnant Women With Congenital Heart Disease in a Georgia Medicaid Dataset

BACKGROUND: Survival to reproductive age is common among women with congenital heart disease (CHD). We evaluated fetal and obstetric complications in a population-based cohort of women with CHD enrolled in Georgia (GA) Medicaid. METHODS: We identified 3904 pregnancies (96.0% singleton) among 2267 women with CHD, ages 11-50 (49.2% Black; 76.3% urban), enrolled in GA Medicaid from 2008 to 2019. Diagnoses and outcomes were defined using International Classification of Diseases (ICD) codes. Associations between CHD anatomic group and fetal and obstetric outcomes were assessed using chi-square tests. Multivariate logistic regression models were adjusted for covariates, using isolated coronary anomalies as the reference group. RESULTS: Obstetric complications occurred in 36.2% of pregnancies and did not differ significantly by CHD anatomic group (p = 0.5301). Fetal complications were significantly more common in all CHD groups compared with coronary anomalies, including higher prematurity and fetal growth restriction (FGR) rates (prematurity: p < 0.0001; FGR: p = 0.0238). In multivariate analysis, complex right ventricular outflow tract (RVOT) defects, shunts, univentricular lesions, transposition of the great arteries (TGA), left-sided and right-sided valve lesions were associated with increased odds of fetal complications compared to coronary anomaly CHD [aOR, 95% CI: complex RVOT 4.85, 1.85-12.71; shunt 4.00, 1.56-10.26; univentricular: 3.65, 1.35-9.90; TGA: 3.64, 1.24-10.63; left-sided valve: 3.23, 1.26-8.31; and right-sided valve: 3.11, 1.19-8.12]. CONCLUSIONS: Pregnancies among women with CHD carry increased risk of prematurity and FGR rates across CHD anatomic groups compared with coronary anomalies. Close monitoring for fetal and obstetric complications is warranted regardless of CHD subtype, including those traditionally considered to have lower maternal risk.