Obstetrical and neonatal outcomes in patients with surgically repaired heart disease.

BACKGROUND: Congenital and acquired heart disease complicate 1% to 4% of pregnancies in the United States. Beyond the risks of the underlying maternal congenital heart disease, cardiac surgery and its sequelae, such as surgical scarring resulting in higher rates of arrhythmias and implanted valves altering anticoagulation status, have potential implications that could affect gestation and delivery. OBJECTIVE: This study aimed to investigate whether history of maternal cardiac surgery is associated with adverse obstetrical or neonatal outcomes compared with patients without a history of cardiac disease or surgery, considered "healthy controls." STUDY DESIGN: This is a secondary analysis of retrospective cohort studies performed at a tertiary care facility in the United States comparing obstetrical outcomes in patients with a history of open cardiac surgery who delivered from January 2007 to December 2018 with healthy controls, who delivered from April 2020 to July 2020. There were 74 pregnancies in 61 patients with a history of open cardiac surgery that were compared with pregnancies in healthy controls. Of the 74 pregnancies, 65 were successfully matched based on gestational age to controls at a 1:3 (case-to-control) ratio. The remainder of cases were matched at a 1:2 or 1:1 ratio; therefore, a total of 219 control pregnancies were included in the analysis. Our primary outcome was the incidence of hypertensive disorders of pregnancy, as well as cesarean delivery, in patients with a history of open cardiac surgery compared with healthy controls. Our secondary outcome was the incidence of low-birthweight neonates in patients with a history of open cardiac surgery compared with healthy controls. RESULTS: Patients with a history of cardiac surgery were not more likely to have any hypertensive disorder diagnosed than healthy controls. Patients with a history of cardiac surgery were more likely to have an operative delivery (P<.0001) but equally likely to have a cesarean delivery (P=.528) compared with healthy controls. Birthweight was not statistically different of 2655±808 g in neonates born to patients with a history of cardiac surgery vs 2844±830 g born to healthy controls (P=.092). CONCLUSION: Patients with a history of cardiac surgery may not be at higher risk of hypertensive disorder diagnosis during pregnancy. Similarly, most patients with a history of cardiac surgery are also likely not at higher risk of cesarean delivery or low-birthweight neonates.

A Noninterventional Cohort Study Assessing Time to All-Cause Treatment Discontinuation After Initiation of Aripiprazole Once Monthly or Daily Oral Atypical Antipsychotic Treatment in Patients With Recent-Onset Schizophrenia.

Introduction: Aripiprazole once-monthly 400 mg (extended-release injectable suspension) is effective in long-term maintenance treatment of schizophrenia based on clinical studies. As study results may not reflect clinical practice, we compared treatment persistence with aripiprazole once-monthly 400 mg versus daily oral atypical antipsychotics in a naturalistic setting.Methods: This was an observational, noninterventional study of patients (aged 18-35 years) with recent-onset schizophrenia (< 5 years post diagnosis) who initiated maintenance treatment with aripiprazole once-monthly 400 mg or any daily oral atypical antipsychotic during a schizophrenia-related hospitalization or within 3 months post hospital discharge (timeframe: July 13, 2017-July 31, 2019). Data were from patient files/obtained during routine visits. Patients were followed for ≤ 12 months or until all-cause treatment discontinuation (including lost to follow-up), whichever came first. Data were analyzed using a sample constructed with inverse probability of treatment weighting (IPTW).Results: Among 357 patients (aripiprazole once-monthly 400 mg: 215, oral atypical antipsychotics: 142), all-cause treatment discontinuation occurred in 87 (41%) of aripiprazole once-monthly 400 mg, 68 (48%) of oral atypical antipsychotic patients over 52 weeks. In the IPTW sample, time to all-cause discontinuation was significantly different between both groups in favor of aripiprazole once-monthly 400 mg (hazard ratio = 1.46; 95% CI, 1.05-2.03; P = .023). Generalizability of results to the overall population with schizophrenia was limited due to incomplete overlap of patient characteristics between cohorts. The primary reason for treatment discontinuation in both groups was voluntary discontinuation by subject (aripiprazole once-monthly 400 mg: 11%; oral atypical antipsychotics: 8%).Conclusions: In a naturalistic setting, younger patients with recent-onset schizophrenia treated with aripiprazole once-monthly 400 mg after hospitalization tended to discontinue treatment later than patients treated with daily oral atypical antipsychotics.Trial Registration: ClinicalTrials.gov identifier: NCT03130465.