Maternal and Fetal Complications Among Pregnant Women with Congenital Heart Disease
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Background
Survival to reproductive age is now common among women with congenital heart disease (CHD). Pregnancies to women with CHD may be at higher risk for maternal and fetal complications. This study examines maternal and fetal outcomes among pregnant women with CHD covered by Georgia Medicaid.
Methods
This case-control study identified 3,461 pregnant women with CHD, 11-50 years, covered by Georgia Medicaid from 2008-2019, who had 5,904 pregnancies. Maternal and fetal outcomes were determined by ICD-9-CM and ICD-10-CM codes at the encounter level. The association of select covariables, including race/ethnicity, social deprivation, CHD native anatomy, rurality, and presence of pre-existing maternal comorbidities on maternal and fetal outcomes were analyzed using chi-square. Multivariate logistic regression models adjusting for covariates were conducted.
Results
Women with severe CHD had more fetal complications and fetal deaths/stillbirths than women with non-severe CHD (53.9% vs. 50.2% p=0.01 and 4.4% vs. 3.0%, p=0.007, respectively), but no difference in maternal complications were revealed (60.7% vs. 59.9%, p=ns). In multivariate analysis, pregnancies to women with severe CHD were 25% more likely to have fetal complications than pregnancies to women with non-severe CHD (aOR 1.25, 95CI 1.07-1.47). The most common fetal complications by maternal CHD anatomy were fetal distress, fetal growth restriction, and preterm delivery (27.2% vs. 23.1%, 27.6% vs. 19.4%, 23.1% vs. 19.6% for severe vs. non-severe, respectively, p=<0.05).
Conclusions
Pregnancies to women with CHD were associated with a high rate of maternal and fetal complications. Fetal complications, fetal death and stillbirth were highest among women with severe CHD.
