ABSTRACT
OBJECTIVE: To estimate the effect of maternal heart disease on fetal growth and neonatal outcomes. METHODS: A retrospective cohort study of all women with congenital and acquired heart disease admitted at Chelsea and Westminster Hospital between 1994 and 2010 was performed. The women who delivered immediately before and immediately after each index pregnancy were used as controls. Data were obtained from medical and obstetric notes. Birth weight percentiles were calculated using a customized birth weight percentile program, and neonatal complications (preterm birth, perinatal mortality, and recurrence of congenital heart disease) were noted. RESULTS: Median birth weight percentile was significantly lower in the heart disease group (31) compared with the control group (49;P.001 Mann-Whitney U test [corrected].The rate of neonatal complications was significantly higher in the heart disease group (34% compared with 15%). Preterm birth occurred in 42 (13%) pregnancies, of which 67% were iatrogenic. Eighty-one (25%) newborns in the heart disease group were small for gestational age, and there were four stillbirths and four neonatal deaths (perinatal mortality rate 20 per 1,000). CONCLUSION: This cohort study suggests a significant reduction in fetal growth rates associated with maternal heart disease, which is also associated with preterm delivery and reduced birth weight. The presence of maternal cyanosis and a reduced cardiac output are the most significant predictors. LEVEL OF EVIDENCE: II.
Subject(s)
Birth Weight , Fetal Growth Retardation/etiology , Heart Diseases/complications , Obstetric Labor Complications/epidemiology , Pregnancy Complications, Cardiovascular/diagnosis , Adult , Case-Control Studies , Confidence Intervals , Female , Fetal Distress/epidemiology , Fetal Distress/etiology , Fetal Distress/physiopathology , Fetal Growth Retardation/epidemiology , Fetal Growth Retardation/physiopathology , Fetal Monitoring/methods , Heart Diseases/diagnosis , Humans , Incidence , Infant Mortality , Infant, Newborn , Infant, Premature , Maternal Welfare , Multivariate Analysis , Obstetric Labor Complications/etiology , Odds Ratio , Pregnancy , Pregnancy Complications, Cardiovascular/epidemiology , Pregnancy Outcome , Pregnancy, High-Risk , Prenatal Care/methods , Reference Values , Retrospective Studies , Risk Assessment , United KingdomABSTRACT
OBJECTIVE: To determine maternal and neonatal outcomes in women with a systemic right ventricle (RV). STUDY DESIGN: A retrospective (historical) cohort study of maternal and neonatal outcomes at a tertiary referral academic obstetric unit (Chelsea and Westminster Hospital, London). RESULTS: Nineteen pregnancies in 14 women with a systemic RV were compared with 76 controls. There were no maternal deaths. In the study group cardiac complications occurred in six (32%) pregnancies. Obstetric complications occurred in four (21%) case pregnancies, not significantly higher than in the control group. The rate of neonatal complication was significantly higher in the study population with neonatal complications in 12 (63%) case pregnancies compared with 13 (17%) control pregnancies. The median birthweight centile was 9 in the study population, significantly lower than the control population. CONCLUSIONS: Our cohort study demonstrates high maternal and neonatal morbidity and low birthweight in the presence of a systemic RV. Cardiac complications were more common in women with RV dysfunction and arrhythmias prior to pregnancy. Preconception counselling and tertiary care during pregnancy for these patients is highly advisable.
