Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island; Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York; University at Albany School of Public Health, Rensselaer, New York.
Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York; University at Albany School of Public Health, Rensselaer, New York.
J Am Coll Cardiol. 2019 May 7;73(17):2181-2191. doi: 10.1016/j.jacc.2019.01.069.
Pregnant women with congenital heart defects (CHDs) may be at increased risk for adverse events during delivery.
This study sought to compare comorbidities and adverse cardiovascular, obstetric, and fetal events during delivery between pregnant women with and without CHDs in the United States.
Comorbidities and adverse delivery events in women with and without CHDs were compared in 22,881,691 deliveries identified in the 2008 to 2013 National Inpatient Sample using multivariable logistic regression. Among those with CHDs, associations by CHD severity and presence of pulmonary hypertension (PH) were examined.
There were 17,729 deliveries to women with CHDs (77.5 of 100,000 deliveries). These women had longer lengths of stay and higher total charges than women without CHDs. They had greater odds of comorbidities, including PH (adjusted odds ratio [aOR]: 193.8; 95% confidence interval [CI]: 157.7 to 238.0), congestive heart failure (aOR: 49.1; 95% CI: 37.4 to 64.3), and coronary artery disease (aOR: 31.7; 95% CI: 21.4 to 47.0). Greater odds of adverse events were observed, including heart failure (aOR: 22.6; 95% CI: 20.5 to 37.3), arrhythmias (aOR: 12.4; 95% CI: 11.0 to 14.0), thromboembolic events (aOR: 2.4; 95% CI: 2.0 to 2.9), pre-eclampsia (aOR: 1.5; 95% CI: 1.3 to 1.7), and placenta previa (aOR: 1.5; 95% CI: 1.2 to 1.8). Cesarean section, induction, and operative vaginal delivery were more common, whereas fetal distress was less common. Among adverse events in women with CHDs, PH was associated with heart failure, hypertension in pregnancy, pre-eclampsia, and pre-term delivery; there were no differences in most adverse events by CHD severity.
Pregnant women with CHDs were more likely to have comorbidities and experience adverse events during delivery. These women require additional monitoring and care.
患有先天性心脏病 (CHD) 的孕妇在分娩期间可能面临更多的不良事件风险。
本研究旨在比较美国患有和不患有 CHD 的孕妇在分娩期间的合并症和不良心血管、产科和胎儿事件。
使用多变量逻辑回归比较了 2008 年至 2013 年全国住院患者样本中 22881691 例分娩中有和无 CHD 的孕妇的合并症和不良分娩事件。在患有 CHD 的孕妇中，还检查了 CHD 严重程度和是否存在肺动脉高压 (PH) 的关联。
共有 17729 例分娩是给患有 CHD 的孕妇（每 100000 例分娩中有 77.5 例）。这些女性的住院时间和总费用都比没有 CHD 的女性长。她们患合并症的几率更高，包括 PH（调整后的优势比 [aOR]：193.8；95%置信区间 [CI]：157.7 至 238.0）、充血性心力衰竭（aOR：49.1；95% CI：37.4 至 64.3）和冠状动脉疾病（aOR：31.7；95% CI：21.4 至 47.0）。观察到更多的不良事件发生的几率更高，包括心力衰竭（aOR：22.6；95% CI：20.5 至 37.3）、心律失常（aOR：12.4；95% CI：11.0 至 14.0）、血栓栓塞事件（aOR：2.4；95% CI：2.0 至 2.9）、子痫前期（aOR：1.5；95% CI：1.3 至 1.7）和前置胎盘（aOR：1.5；95% CI：1.2 至 1.8）。剖宫产、引产和阴道分娩更常见，而胎儿窘迫则不常见。在患有 CHD 的孕妇的不良事件中，PH 与心力衰竭、妊娠高血压、子痫前期和早产有关；CHD 严重程度不同，大多数不良事件没有差异。
患有 CHD 的孕妇更有可能患有合并症并在分娩期间出现不良事件。这些女性需要额外的监测和护理。
