Key result
Pregnant women with moderate or great complexity congenital heart disease had a significantly higher risk of peripartum cardiovascular events compared to those with simple congenital heart disease (adjusted OR 10.24 and 5.78, respectively).
Why the study?
Increasing maternal age at delivery raises maternal risk in women with CHD, requiring a comprehensive management approach to understand factors determining peripartum safety.
Cohort (n=217)
Yes
Multiparity, NYHA functional class, and CHD severity are important predictors of peripartum cardiovascular events in pregnant women with congenital heart disease.
Answers are grounded in this paper and cite their sources.
Multiparity, NYHA class, and CHD severity predict peripartum CV events; supports risk stratification but leaves open prospective validation before guiding practice.
BACKGROUND: The average maternal age at delivery, and thus the associated maternal risk are increasing including in women with congenital heart disease (CHD). A comprehensive management approach is therefore required for pregnant women with CHD. The present study aimed to investigate the factors determining peripartum safety in women with CHD. METHODS AND RESULTS: We retrospectively collected multicenter data for 217 pregnant women with CHD (age at delivery: 31.4±5.6 years; NYHA classifications I and II: 88.9% and 7.4%, respectively). CHD severity was classified according to the American College of Cardiology/American Heart Association guidelines as simple (n=116), moderate complexity (n=69), or great complexity (n=32). Cardiovascular (CV) events (heart failure: n=24, arrhythmia: n=9) occurred in 30 women during the peripartum period. Moderate or great complexity CHD was associated with more CV events during gestation than simple CHD. CV events occurred earlier in women with moderate or great complexity compared with simple CHD. Number of deliveries (multiparity), NYHA functional class, and severity of CHD were predictors of CV events. CONCLUSIONS: This study identified not only the severity of CHD according to the ACC/AHA and NYHA classifications, but also the number of deliveries, as important predictive factors of CV events in women with CHD. This information should be made available to women with CHD and medical personnel to promote safe deliveries.
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Yamasaki et al. (2019) conducted a cohort in Congenital heart disease in pregnancy (n=217). Moderate complexity congenital heart disease vs. Simple congenital heart disease was evaluated on Cardiovascular events (heart failure, thrombosis, and arrhythmia requiring treatment) during the peripartum period (OR 10.24, 95% CI 2.10-49.91, p=0.004). Pregnant women with moderate or great complexity congenital heart disease had a significantly higher risk of peripartum cardiovascular events compared to those with simple congenital heart disease (adjusted OR 10.24 and 5.78, respectively).
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