Maternal cardiovascular events during childbirth among women with congenital heart disease. Issue 2 (11th October 2011)

• Record Type: Journal Article
• Authors: Opotowsky, Alexander R; Siddiqi, Omar K; D'Souza, Benjamin; Webb, Gary D; Fernandes, Susan M; Landzberg, Michael J
• Is Part Of: Heart. Volume 98:Issue 2(2012)
• Page Start: 145
• Page End: 151
• Publication Date: 2011-10-11
• Subjects: Congenital heart disease -- adults -- epidemiology -- pregnancy -- cesarean section; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2011-300828
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objectives: To define the epidemiology of adverse cardiovascular events among women with congenital heart disease (CHD) hospitalised for childbirth in the USA. Design and setting: The 1998–2007 Nationwide Inpatient Sample, an administrative dataset representative of overall US hospital admissions, was used to identify hospitalisations for delivery. Main outcome measures: Logistic regression was used to estimate ORs for cardiovascular outcomes (arrhythmia, heart failure, cerebrovascular accident, embolism, death or a combined outcome) for women with and without CHD. Covariates included age, number of medical comorbidites, pulmonary hypertension, hospital teaching status, insurance status and method of delivery. Results: Annual deliveries for women with CHD increased 34.9% from 1998 to 2007 compared with an increase of 21.3% in the general population. Women with CHD were more likely to sustain a cardiovascular event (4042/100 000 vs 278/100 000 deliveries, univariate OR 15.1, 95% CI 13.1 to 17.4, multivariable OR 8.4, 95% CI 7.0 to 10.0). Arrhythmia, the most common cardiovascular event, was more frequent among women with CHD (2637/100 000 vs 210/100 000, univariate OR 12.9, 95% CI 10.9 to 15.3, multivariable OR 8.3, 95% CI 6.7 to 10.1). Death occurred in 150/100 000 patients with CHD compared with 8.2/100 000 patients without CHD (multivariable OR 6.7, 95% CI 2.9 to 15.4). Complex CHD was associated with greater odds of having an adverse cardiovascular event than simple CHD (8158/100 000 vs 3166/100 000, multivariable OR 2.0, 95% CI 1.4 to 3.0). Conclusions: Maternal CHD is associated with a markedly increased risk of adverse cardiovascular events and death during admission for delivery.