Pregnancy outcomes in women with congenital heart disease

Background - Pregnant women with congenital heart disease are at increased risk for cardiac and neonatal complications, yet risk factors for adverse outcomes are not fully defined. Methods and Results - Between January 1998 and September 2004, 90 pregnancies at age 27.7 +/- 6.1 years were followed in 53 women with congenital heart disease. Spontaneous abortions occurred in 11 pregnancies at 10.8 +/- 3.7 weeks, and 7 underwent elective pregnancy termination. There were no maternal deaths. Primary maternal cardiac events complicated 19.4% of ongoing pregnancies, with pulmonary edema in 16.7% and sustained arrhythmias in 2.8%. Univariate risk factors included prior history of heart failure ( odds ratio [ OR], 15.5), NYHA functional class >= 2 ( OR, 5.4), and decreased subpulmonary ventricular ejection fraction ( OR, 7.7). Independent predictors were decreased subpulmonary ventricular ejection fraction and/or severe pulmonary regurgitation ( OR, 9.0) and smoking history ( OR, 27.2). Adverse neonatal outcomes occurred in 27.8% of ongoing pregnancies and included preterm delivery (20.8%), small for gestational age (8.3%), respiratory distress syndrome ( 8.3%), intraventricular hemorrhage (1.4%), intrauterine fetal demise ( 2.8%), and neonatal death ( 1.4%). A subaortic ventricular outflow tract gradient > 30 mm Hg independently predicted an adverse neonatal outcome ( OR, 7.5). Cardiac risk assessment was improved by including decreased subpulmonary ventricular systolic function and/or severe pulmonary regurgitation ( OR, 10.3) in a previously proposed risk index developed in pregnant women with acquired and congenital heart disease. Conclusions - Maternal cardiac and neonatal complication rates are considerable in pregnant women with congenital heart disease. Patients with impaired subpulmonary ventricular systolic function and/or severe pulmonary regurgitation are at increased risk for adverse cardiac outcomes.