The Impact of Maternal Congenital Heart Disease on Pregnancy Outcomes in Malta – a Retrospective Study

Maryanne Caruana, Miriam Gatt, Oscar Aquilina, Charles Savona Ventura, Victor Grech, Jane Somerville

Abstract


Background: Most female patients with congenital heart disease (CHD) are becoming pregnant.  Maternal CHD can have a negative impact on mother and foetus. This is the first study investigating pregnancy outcomes in Maltese grown-up congenital heart disease (GUCH) patients and one of few to compare these with outcomes in women without heart disease.

Methods: Known GUCH pregnancies for the period of 2007-2014 were extracted from our database (GUCH cohort) and cardiovascular outcomes retrieved from hospital notes.  A control cohort of 540 pregnancies in women without cardiovascular disease was generated through twenty-fold random matching based on subject age from among all pregnancies in Maltese nationals for the same 8-year period.  Obstetric and offspring outcomes were compared between the two cohorts.

Results:  The GUCH cohort consisted of 27 pregnancies in 24 women.  Only 1/27 patients (3.7%) had cardiovascular complications.  Elective Caesarean sections were commoner (29.6% vs. 15.4%) and unassisted vaginal deliveries less frequent (51.9% vs. 64.6%) in the GUCH cohort (p=0.02).  Obstetric complication rates were similar.  GUCH women had smaller babies (median 3030g vs. 3230g; p=0.045) and showed a trend towards more small-for-gestational age babies (18.5% vs. 8.4%; p=0.08) and congenital malformations (7.4% vs. 2.4%; p=0.06).

Conclusions:  Despite the potential adverse effects of maternal CHD on mother and foetus, most pregnancies are uncomplicated and outcomes comparable to those in women without heart disease, particularly if baseline clinical status is good.  Based on our findings, it is being proposed that prospective mothers be counselled about the possibility of having smaller infants.


Keywords


Congenital Heart Defects; Pregnancy; Cardiovascular Pregnancy Complications

Full Text:

416

References


Thompson JL, Kuklina EV, Bateman BT, Callaghan WM, James AH, Grotegut CA. Medical and Obstetric Outcomes Among Pregnant Women With Congenital Heart Disease. Obstet Gynecol. 2015;126(2):346-354. DOI: 10.1097/AOG. 0000000000000973

Moghbeli N, Pare E, Webb G. Practical assessment of maternal cardiovascular risk in pregnancy. Congenit Heart Dis. 2008;3(5):308-316. DOI: 10.1111/j.1747-0803.2008.00207.x

Khairy P, Ouyang DW, Fernandes SM, Lee-Parritz A, Economy KE, Landzberg MJ. Pregnancy outcomes in women with congenital heart disease. Circulation. 2006;113(4):517-524. DOI: 10.1161/CIRCULATIONAHA.105.589655

Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC, et al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104(5):515-521. DOI: 10.1161/hc3001.093437

Lu CW, Shih JC, Chen SY, Chiu HH, Wang JK, Chen CA, et al. Comparison of 3 Risk Estimation Methods for Predicting Cardiac Outcomes in Pregnant Women With Congenital Heart Disease. Circ J. 2015;79(7):1609-1617. DOI: 10.1253/circj.CJ-14-1368

Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147-3197. DOI: 10.1093/eurheartj/ehr218

Thorne S, MacGregor A, Nelson-Piercy C. Risks of contraception and pregnancy in heart disease. Heart. 2006;92(10):1520-1525. DOI: 10/1136/hrt.2006.095240

Drenthen W, Boersma E, Balci A, Moons P, Roos-Hesselink JW, Mulder BJ, et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J. 2010;31(17):2124-2132. DOI: 10.1093/eurheartj/ehq200

National Statistics Office. Malta in Figures 2014. Available from: http://nso.gov.mt/en/publicatons/Pages/Publications-by-Date.aspx.

National Obstetrics Information System (NOIS) 2016. Available from: http://health.gov.mt/en/dhir/Pages/Registries/births.aspx.

Grech V. Spectrum of congenital heart disease in Malta. An excess of lesions causing right ventricular outflow tract obstruction in a population-base study. Eur Heart J. 1998;19(3):521-525.

British Society of Echocardiography. Protocols and Guidelines 2016. Available from: https://www.bsecho.org/education/.

Drenthen W, Pieper PG, Roos-Hesselink JW, van Lottum WA, Voors AA, Mulder BJ, et al. Outcome of pregnancy in women with congenital heart disease: a literature review. Journal of the American College of Cardiology. 2007;49(24):2303-2311. DOI: 10.1016/j.jacc.2007.03.027

Siu SC, Colman JM, Sorensen S, Smallhorn JF, Farine D, Amankwah KS, et al. Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac disease. Circulation. 2002;105(18):2179-2184. DOI: 10.1161/01.CIR.0000015699.48605.08

Avila WS, Rossi EG, Ramires JA, Grinberg M, Bortolotto MR, Zugaib M, et al. Pregnancy in patients with heart disease: experience with 1,000 cases. Clin Cardiol. 2003;26(3):135-142. DOI: 10.1002/clc.4960260308

Opotowsky AR, Siddiqi OK, D'Souza B, Webb GD, Fernandes SM, Landzberg MJ. Maternal cardiovascular events during childbirth among women with congenital heart disease. Heart. 2012;98(2):145-151. DOI: 10.1136/heartjnl-2001-300828

Roos-Hesselink JW, Ruys TP, Stein JI, Thilen U, Webb GD, Niwa K, et al. Outcome of pregnancy in patients with structural or ischaemic heart disease: results of a registry of the European Society of Cardiology. Eur Heart J. 2013;34(9):657-665. DOI: 10.1093/eurheartj/ehs270

Balci A, Drenthen W, Mulder BJ, Roos-Hesselink JW, Voors AA, Vliegen HW, et al. Pregnancy in women with corrected tetralogy of Fallot: occurrence and predictors of adverse events. Am Heart J. 2011;161(2):307-313. DOI: 10.1016/j.ahj.2010.10.027

Veldtman GR, Connolly HM, Grogan M, Ammash NM, Warnes CA. Outcomes of pregnancy in women with tetralogy of Fallot. J Am Coll Cardiol. 2004;44(1):174-180. DOI: 10.1016/j.jacc.2003.11.067

Pedersen LM, Pedersen TA, Ravn HB, Hjortdal VE. Outcomes of pregnancy in women with tetralogy of Fallot. Cardiol Young. 2008;18(4):423-429. DOI: 10.1017/S1047951108002345

Drenthen W, Pieper PG, Ploeg M, Voors AA, Roos-Hesselink JW, Mulder BJM, et al. Risk of complications during pregnancy after Senning or Mustard (atrial) repair of complete transposition of the great arteries. Eur Heart J. 2005;26(23):2588-2595. DOI: 10.1093/eurheartj/ehj472

Canobbio MM, Morris CD, Graham TP, Landzberg MJ. Pregnancy outcomes after atrial repair for transposition of the great arteries. Am J Cardiol. 2006;98(5):668-672. DOI: 10.1016/j.amjcard.2006.03.050

Trigas V, Nagdyman N, Pildner von Steinburg S, Oechslin E, Vogt M, Berger F, et al. Pregnancy-related obstetric and cardiologic problems in women after atrial switch operation for transposition of the great arteries. Circ J. 2014;78(2):443-449. DOI: 10.1253/circj.CJ-12-1051

Caruana M, Grech V, Somerville J. Pregnancy in atriopulmonary connection and total cavopulmonary connection - a comparison of two cases. Cardiol Young. 2012;22(5):600-602. DOI: 10.1017/S1047951111002022

Hrycyk J, Kaemmerer H, Nagdyman N, Hamann M, Schneider K, Kuschel B. Mode of Delivery and Pregnancy Outcome in Women with Congenital Heart Disease. PloS One. 2016;11(12):e0167820. DOI: 10.1371/journal.pone.0167820

Stangl V, Schad J, Gossing G, Borges A, Baumann G, Stangl K. Maternal heart disease and pregnancy outcome: a single-centre experience. Eur J Heart Fail. 2008;10(9):855-860. DOI: 10.1016/j.ejheart.2008.07.017

Gelson E, Curry R, Gatzoulis MA, Swan L, Lupton M, Steer P, et al. Effect of maternal heart disease on fetal growth. Obstet Gynecol. 2011;117(4):886-891. DOI: 10.1097/AOG.0b013e31820cab69

Greutmann M, Pieper PG. Pregnancy in women with congenital heart disease. Eur Heart J. 2015;36(37):2491-2499. DOI: 10.1093/eurheartj/ehv288

Greutmann M, Silversides CK. The ROPAC registry: a multicentre collaboration on pregnancy outcomes in women with heart disease. Eur Heart J. 34(9):634-635. DOI: 10.1093/eurheartj/ehs335

Shewan L.G., Coats A.J.S., Henein M. Requirements for Ethical Publishing in Biomedical Journals. International Cardiovascular Forum Journal. 2015;2:2. http://dx.doi.org/10.17987/icfj.v2i1.4




DOI: http://dx.doi.org/10.17987/icfj.v11i0.416

Copyright (c) 2017 The Authors

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.