Peripartum Management of Pregnant Women With Congenital Heart Disease

• Published in: Circulation Journal 2019/10/25, Vol.83(11), pp.2257-2264
• Main Authors: Yamasaki, Keiko, Sawatari, Hiroyuki, Konagai, Nao, Kamiya, Chizuko A., Yoshimatsu, Jun, Muneuchi, Jun, Watanabe, Mamie, Fukuda, Terunobu, Mizuno, Atsushi, Sakamoto, Ichiro, Yamamura, Kenichiro, Ohkusa, Tomoko, Tsutsui, Hiroyuki, Niwa, Koichiro, Chishaki, Akiko
• Format: Article
• Language: English
• Subjects: Adult; Cardiovascular events; Congenital heart disease; Female; Heart Defects, Congenital - complications; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - therapy; Humans; Japan; Longitudinal Studies; Maternal Age; Maternal Health; Parity; Patient Safety; Peripartum Period; Pregnancy; Pregnancy Complications, Cardiovascular - etiology; Pregnancy Complications, Cardiovascular - physiopathology; Pregnancy Complications, Cardiovascular - prevention & control; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-19-0369

Background:The average maternal age at delivery, and thus the associated maternal risk are increasing including in women with congenital heart disease (CHD). A comprehensive management approach is therefore required for pregnant women with CHD. The present study aimed to investigate the factors determining peripartum safety in women with CHD.Methods and Results:We retrospectively collected multicenter data for 217 pregnant women with CHD (age at delivery: 31.4±5.6 years; NYHA classifications I and II: 88.9% and 7.4%, respectively). CHD severity was classified according to the American College of Cardiology/American Heart Association guidelines as simple (n=116), moderate complexity (n=69), or great complexity (n=32). Cardiovascular (CV) events (heart failure: n=24, arrhythmia: n=9) occurred in 30 women during the peripartum period. Moderate or great complexity CHD was associated with more CV events during gestation than simple CHD. CV events occurred earlier in women with moderate or great complexity compared with simple CHD. Number of deliveries (multiparity), NYHA functional class, and severity of CHD were predictors of CV events.Conclusions:This study identified not only the severity of CHD according to the ACC/AHA and NYHA classifications, but also the number of deliveries, as important predictive factors of CV events in women with CHD. This information should be made available to women with CHD and medical personnel to promote safe deliveries.