Key result
Maternal congenital heart disease increased the risk of preterm birth compared to women without CHD, with hazard ratios of 1.33 for simple, 1.45 for moderate, and 3.26 for complex CHD.
Why the study?
To investigate the hypothesized increased risk of preterm birth and small-for-gestational-age infants in women with congenital heart disease, focusing on the potential modifying effect of socioeconomic status.
Does maternal congenital heart disease increase the risk of preterm birth and small for gestational age infants compared to women without congenital heart disease?
Cohort (n=933,149)
Yes
Does maternal congenital heart disease increase the risk of preterm birth and small for gestational age infants compared to women without congenital heart disease?
Hazard Ratio: 1.33 (95% CI 1.11–1.59)
Women with congenital heart disease are at an increased, severity-dependent risk of delivering preterm or small for gestational age infants, independent of socioeconomic status.
May support enhanced antenatal monitoring in women with CHD; leaves open whether severity-stratified interventions improve outcomes.
Background We hypothesized that women with congenital heart disease ( CHD ) are at increased risk of giving birth preterm, including very and moderately preterm and giving birth to infants small for gestational age ( SGA ). We aimed to investigate this in a nation‐wide study with focus on the potential modifying effect of socioeconomic status. Methods and Results We performed a cohort study using Danish nation‐wide registers between 1997 and 2014. The exposure, maternal CHD , was subdivided into simple, moderate and complex based on severity of defects. Outcomes were preterm birth and SGA . Cox regression was used to estimate hazard ratios ( HR ). A total of 933 149 births including 3745 births among women with CHD were studied. The risk of giving birth preterm and SGA were higher among women with CHD as compared with women without CHD ; for example, adjusted hazard ratios of preterm birth according to severity: simple 1.33 (95% CI , 1.11–1.59), moderate 1.45 (95% CI , 1.14–1.83) and complex 3.26 (95% CI , 2.41–4.40). Same pattern was seen for very and moderately preterm births and SGA . Education was a strong predictor of both preterm birth and SGA but did not modify the association between maternal congenital heart disease and preterm birth ( P =0.38) or SGA ( P =0.99). Conclusions Women with CHD were at increased risk of preterm birth both, moderately and very preterm, as well as giving birth to infants SGA . Education was a strong predictor of both preterm birth and SGA but the association between CHD and risk of preterm birth and SGA was independent of educational level.
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Kloster et al. (2019) conducted a cohort in Congenital heart disease in pregnancy (n=933,149). Maternal congenital heart disease vs. Women without congenital heart disease was evaluated on Preterm birth (HR 1.33, 95% CI 1.11-1.59). Maternal congenital heart disease increased the risk of preterm birth compared to women without CHD, with hazard ratios of 1.33 for simple, 1.45 for moderate, and 3.26 for complex CHD.
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