Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at Term
Background Current recommendations for delivery timing of pregnant persons with congenital heart disease (CHD) are based on expert opinion. Justification for early‐term birth is based on the theoretical concern of increased cardiovascular stress. The objective was to evaluate whether early‐term birt...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.025791 |
| _version_ | 1811215178884186112 |
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| author | Thalia Mok Allison Woods Adam Small Mary M. Canobbio Megha D. Tandel Lorna Kwan Gentian Lluri Leigh Reardon Jamil Aboulhosn Jeannette Lin Yalda Afshar |
| author_facet | Thalia Mok Allison Woods Adam Small Mary M. Canobbio Megha D. Tandel Lorna Kwan Gentian Lluri Leigh Reardon Jamil Aboulhosn Jeannette Lin Yalda Afshar |
| author_sort | Thalia Mok |
| collection | DOAJ |
| description | Background Current recommendations for delivery timing of pregnant persons with congenital heart disease (CHD) are based on expert opinion. Justification for early‐term birth is based on the theoretical concern of increased cardiovascular stress. The objective was to evaluate whether early‐term birth with maternal CHD is associated with lower adverse maternal or neonatal outcomes. Methods and Results This is a retrospective cohort study of pregnant persons with CHD who delivered a singleton after 37 0/7 weeks gestation at a quaternary care center with a multidisciplinary cardio‐obstetrics care team between 2013 and 2021. Patients were categorized as early‐term (37 0/7 to 38 6/7 weeks) or full‐term (≥39 0/7) births and compared. Multivariable logistic regression was conducted to calculate the adjusted odds ratio for the primary outcomes. The primary outcomes were composite adverse cardiovascular, maternal obstetric, and adverse neonatal outcome. Of 110 pregnancies delivering at term, 55 delivered early‐term and 55 delivered full‐term. Development of adverse cardiovascular and maternal obstetric outcome was not significantly different by delivery timing. The rate of composite adverse neonatal outcomes was significantly higher in early‐term births (36% versus 5%, P<0.01). After adjusting for confounding variables, early‐term birth remained associated with a significantly increased risk of adverse neonatal outcomes (adjusted odds ratio 11.55 [95% CI, 2.59–51.58]). Conclusions Early‐term birth for pregnancies with maternal CHD was associated with an increased risk of adverse neonatal outcomes, without an accompanying decreased rate in adverse cardiovascular or obstetric outcomes. In the absence of maternal or fetal indications for early birth, induction of labor before 39 weeks for pregnancies with maternal CHD should be reserved for routine obstetrical indications. |
| first_indexed | 2024-04-12T06:17:46Z |
| format | Article |
| id | doaj.art-0c48a9c93cf44fa1b533f1e2ce7d0af7 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T06:17:46Z |
| publishDate | 2022-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-0c48a9c93cf44fa1b533f1e2ce7d0af72022-12-22T03:44:25ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-08-01111610.1161/JAHA.122.025791Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at TermThalia Mok0Allison Woods1Adam Small2Mary M. Canobbio3Megha D. Tandel4Lorna Kwan5Gentian Lluri6Leigh Reardon7Jamil Aboulhosn8Jeannette Lin9Yalda Afshar10Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology University of California Los Angeles CADepartment of Anesthesiology and Perioperative Medicine University of California Los Angeles CADivision of Cardiology, Department of Medicine New York University Langone Health New York NYDivision of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center University of California Los Angeles CADepartment of Urology University of California Los Angeles CADepartment of Urology University of California Los Angeles CADivision of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center University of California Los Angeles CADivision of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center University of California Los Angeles CADivision of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center University of California Los Angeles CADivision of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center University of California Los Angeles CADivision of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology University of California Los Angeles CABackground Current recommendations for delivery timing of pregnant persons with congenital heart disease (CHD) are based on expert opinion. Justification for early‐term birth is based on the theoretical concern of increased cardiovascular stress. The objective was to evaluate whether early‐term birth with maternal CHD is associated with lower adverse maternal or neonatal outcomes. Methods and Results This is a retrospective cohort study of pregnant persons with CHD who delivered a singleton after 37 0/7 weeks gestation at a quaternary care center with a multidisciplinary cardio‐obstetrics care team between 2013 and 2021. Patients were categorized as early‐term (37 0/7 to 38 6/7 weeks) or full‐term (≥39 0/7) births and compared. Multivariable logistic regression was conducted to calculate the adjusted odds ratio for the primary outcomes. The primary outcomes were composite adverse cardiovascular, maternal obstetric, and adverse neonatal outcome. Of 110 pregnancies delivering at term, 55 delivered early‐term and 55 delivered full‐term. Development of adverse cardiovascular and maternal obstetric outcome was not significantly different by delivery timing. The rate of composite adverse neonatal outcomes was significantly higher in early‐term births (36% versus 5%, P<0.01). After adjusting for confounding variables, early‐term birth remained associated with a significantly increased risk of adverse neonatal outcomes (adjusted odds ratio 11.55 [95% CI, 2.59–51.58]). Conclusions Early‐term birth for pregnancies with maternal CHD was associated with an increased risk of adverse neonatal outcomes, without an accompanying decreased rate in adverse cardiovascular or obstetric outcomes. In the absence of maternal or fetal indications for early birth, induction of labor before 39 weeks for pregnancies with maternal CHD should be reserved for routine obstetrical indications.https://www.ahajournals.org/doi/10.1161/JAHA.122.025791congenital heart diseasedelivery timingearly‐term birthmaternal cardiac disease |
| spellingShingle | Thalia Mok Allison Woods Adam Small Mary M. Canobbio Megha D. Tandel Lorna Kwan Gentian Lluri Leigh Reardon Jamil Aboulhosn Jeannette Lin Yalda Afshar Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at Term Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease congenital heart disease delivery timing early‐term birth maternal cardiac disease |
| title | Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at Term |
| title_full | Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at Term |
| title_fullStr | Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at Term |
| title_full_unstemmed | Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at Term |
| title_short | Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at Term |
| title_sort | delivery timing and associated outcomes in pregnancies with maternal congenital heart disease at term |
| topic | congenital heart disease delivery timing early‐term birth maternal cardiac disease |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.025791 |
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