581: Are perinatal complications more frequent in women with congenital heart disease?

A majority of those with congenital heart disease (CHD) now survive into adulthood and many women with CHD wish to pursue pregnancy. Though prior studies have addressed cardiovascular complications, few contemporary data exist regarding obstetric and neonatal outcomes. Our purpose was to examine the association of maternal CHD with adverse perinatal outcomes. This was a retrospective cohort study including 2,250,129 women with singleton gestations delivering at 24-42 weeks' gestational age in California from 2005 through 2008. Women with CHD were compared to controls. Obstetric outcomes included preeclampsia, placental abruption, gestational diabetes mellitus (GDM), preterm premature rupture of membranes, operative vaginal delivery (VD), severe perineal lacerations, blood transfusion and cesarean section (CS). Neonatal outcomes included small for gestational age (SGA), preterm birth (PTB), birthweight, fetal anomalies, neonatal death, and fetal demise. We identified 537 women in the cohort with congenital heart disease. In this cohort, the most common cardiac conditions were pulmonary valve lesions (24%) and aortic valve lesions (24%). Multiple adverse perinatal outcomes were more frequent in the congenital heart disease group compared to controls (Table). Maternal adverse outcomes included an increased risk of preeclampsia (5.0% vs 3.0%, p 0.009), need for blood transfusion (2.3% vs 0.7%, p <0.001), operative VD (7.1% vs 4.5%, p 0.004) and CS (41.7% vs 30.0%, p 0.001). Adverse neonatal outcomes were also more frequent in those with CHD, including PTB (15.0% vs 9.4%, p 0.001), SGA (16.0% vs 10.9%, p 0.001) and fetal anomalies (16.9% vs 6.4%, p 0.001) including cardiac anomalies (3.3% vs 0.5%, p <0.001). All other outcomes were similar between cases and controls. Right compared to left-sided cardiac lesions had an increased rate of SGA (18.6% vs 10.2%, p 0.019) and fetal anomalies (20.6% vs 10.3%, p 0.008) (Figure). Maternal CHD in pregnancy is associated with multiple adverse obstetric and neonatal outcomes. When counseling women with CHD, these risks should be discussed in addition to reviewing the risk of major cardiovascular complications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)