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Effect of maternal age and cardiac disease severity on outcome of pregnancy in women with congenital heart disease

Journal article
Authors Eva Furenäs
Peter J Eriksson
Ulla-Britt Wennerholm
Mikael Dellborg
Published in International Journal of Cardiology
Volume 243
Pages 197-203
ISSN 0167-5273
Publication year 2017
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 197-203
Language en
Keywords Congenital, Heart, Pregnancy, Complication, Risk classification, Age, COMPLICATIONS, POPULATION, RECURRENCE, IMPACT, FETAL, Cardiac & Cardiovascular Systems
Subject categories Obstetrics and gynaecology


Background: There is an increasing prevalence of women with congenital heart defects reaching childbearing age. In western countries women tend to give birth at a higher age compared to some decades ago. We evaluated the CARdiac disease in PREGnancy (CARPREG) and modified World Health Organization (mWHO) risk classifications for cardiac complications during pregnancies in women with congenital heart defects and analyzed the impact of age on risk of obstetric and fetal outcome. Methods: A single-center observational study of cardiac, obstetric, and neonatal complications with data from cardiac and obstetric records of pregnancies in women with congenital heart disease. Outcomes of 496 pregnancies in 232 women, including induced abortion, miscarriage, stillbirth, and live birth were analyzed regarding complications, maternal age, mode of delivery, and two risk classifications: CARPREG and mWHO. Results: There were 28 induced abortions, 59 fetal loss, 409 deliveries with 412 neonates. Cardiac (14%), obstetric (14%), and neonatal (15%) complications were noted, including one maternal death and five stillbirths. The rate of cesarean section was 19%. Age above 35 years was of borderline importance for cardiac complications (p = 0.054) and was not a significant additional risk factor for obstetric or neonatal complications. Both risk classifications had moderate clinical utility, with area under the curve (AUC) 0.71 for CARPREG and 0.65 for mWHO on cardiac complications. Conclusions: Pregnancy complications in women with congenital heart disease are common but severe complications are rare. Advanced maternal age does not seem to affect complication rate. Existing risk classification systems are insufficient in predicting complications. (C) 2017 Elsevier B.V. All rights reserved.

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