Association between pregnancy and long-term cardiac outcomes
As early life interventions for congenital heart disease (CHD) improve, more patients are living to adulthood and considering pregnancy.

Researchers aimed to evaluate the association between pregnancy and subsequent long-term cardiovascular health of women with congenital heart disease (CHD).

A retrospective longitudinal cohort of women receiving the care was carried out. The primary endpoint, a composite adverse cardiac outcome (death, stroke, heart failure, unanticipated cardiac surgery, or requirement of catheterized procedure), was compared between parous (at least one delivery > 20 weeks) and nulliparous women.

Accounting for differential follow-up, the effect of pregnancy was estimated based on time to composite adverse outcome in a proportional hazards regression model adjusted for WHO class, baseline cardiac medications, and the number of prior sternotomies. Participants were also categorized by lesion type including septal defects (VSD, ASD, AVSD, AVCD), right-sided valvular lesions, left-sided valvular lesions, complex cardiac anomalies, and aortopathies to evaluate for a differential effect of pregnancy on the primary outcome when adjusting for lesion type in a sensitivity analysis.

Overall 711 women were eligible for inclusion; 209 were parous and 502 nulliparous. Women were classified by World Health Organization (WHO) class with 86 who were WHO Class I, 76 Class II, 272 Class II-III, 155 Class III, and 26 Class IV.

- Aortic stenosis, bicuspid aortic valve, dilated ascending aorta/aortic root, aortic regurgitation, and pulmonary insufficiency was more common in parous women whereas, dextro transposition of the great arteries (dTGA), Turner syndrome, hypoplastic right heart, left superior vena cava (LSVC), and “other” cardiac diagnoses were more common in nulliparous women.

- In multivariable modeling, pregnancy was associated with the composite adverse cardiac outcome.

- Parous women were more likely to have unanticipated cardiac surgery.

- No other individual components of the primary outcome were statistically different between parous versus nulliparous women in cross-sectional comparisons. The association between pregnancy and the primary outcome was similar in a sensitivity analysis adjusting for cardiac lesion type.

Conclusively, among women with CHD, pregnancy was associated with an increase in subsequent adverse long-term cardiac outcomes.

American Journal of Obstetrics & Gynecology