Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities (K.F.D., R.M.S., E.C.A., M.A.H., S.L.F.), Centers for Disease Control and Prevention, Atlanta, GA.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (N.K.T.), Centers for Disease Control and Prevention, Atlanta, GA.
Circ Cardiovasc Qual Outcomes. 2020 Jun;13(6):e006311. doi: 10.1161/CIRCOUTCOMES.119.006311. Epub 2020 Jun 8.
Background In women with congenital heart defects (CHD), changes in blood volume, heart rate, respiration, and edema during pregnancy may lead to increased risk of adverse outcomes and conditions. The American Heart Association recommends providers of pregnant women with CHD assess cardiac health and discuss risks and benefits of cardiac-related medications. We described receipt of American Heart Association-recommended cardiac evaluations, filled potentially teratogenic or fetotoxic (Food and Drug Administration pregnancy category D/X) cardiac-related prescriptions, and adverse conditions among pregnant women with CHD compared with those without CHD. Methods and Results Using 2007 to 2014 US healthcare claims data, we ascertained a retrospective cohort of women with and without CHD aged 15 to 44 years with private insurance covering prescriptions during pregnancy. CHD was defined as ≥1 inpatient code or ≥2 outpatient CHD diagnosis codes >30 days apart documented outside of pregnancy and categorized as severe or nonsevere. Log-linear regression, accounting for multiple pregnancies per woman, generated adjusted prevalence ratios (aPRs) for associations between the presence/severity of CHD and stillbirth, preterm birth, and adverse conditions from the last menstrual period to 90 days postpartum. We identified 2056 women with CHD (2334 pregnancies) and 1 374 982 women without (1 524 077 pregnancies). During the last menstrual period to 90 days postpartum, 56% of women with CHD had comprehensive echocardiograms and, during pregnancy, 4% filled potentially teratogenic or fetotoxic cardiac-related prescriptions. Women with CHD, compared with those without, experienced more adverse conditions overall (aPR, 1.9 [95% CI, 1.7-2.1]) and, specifically, obstetric (aPR, 1.3 [95% CI, 1.2-1.4]) and cardiac conditions (aPR, 10.2 [95% CI, 9.1-11.4]), stillbirth (aPR, 1.6 [95% CI, 1.1-2.4]), and preterm delivery (aPR, 1.6 [95% CI, 1.4-1.8]). More women with severe CHD, compared with nonsevere, experienced adverse conditions overall (aPR, 1.5 [95% CI, 1.2-1.9]). Conclusions Women with CHD have elevated prevalence of adverse cardiac and obstetric conditions during pregnancy; 4 in 100 used potentially teratogenic or fetotoxic medications, and only half received an American Heart Association-recommended comprehensive echocardiogram.
背景 在患有先天性心脏病 (CHD) 的女性中，妊娠期间血容量、心率、呼吸和水肿的变化可能会增加不良结局和疾病的风险。美国心脏协会建议为患有 CHD 的孕妇提供心脏健康评估，并讨论与心脏相关的药物的风险和益处。我们描述了患有 CHD 的孕妇与没有 CHD 的孕妇相比，接受美国心脏协会推荐的心脏评估、填写潜在致畸或胎儿毒性 (美国食品和药物管理局妊娠类别 D/X) 的与心脏相关的处方以及不良情况的情况。
方法和结果 我们使用 2007 年至 2014 年美国医疗保健索赔数据，确定了一个回顾性队列，该队列包括 15 至 44 岁的有和没有私人保险覆盖妊娠期间处方的 CHD 女性。CHD 的定义为≥1 次住院代码或≥2 次门诊 CHD 诊断代码，间隔>30 天，记录在妊娠之外，并分为严重或非严重。考虑到每个女性的多次妊娠，对数线性回归生成了存在/严重程度 CHD 与死产、早产和从最后一次月经到产后 90 天之间不良情况之间的关联的调整后患病率比 (aPR)。我们确定了 2056 名患有 CHD（2334 例妊娠）的女性和 1374982 名没有 CHD（1524077 例妊娠）的女性。在最后一次月经到产后 90 天期间，56%的 CHD 女性接受了全面的超声心动图检查，在妊娠期间，4%的女性填写了潜在的致畸或胎儿毒性的心脏相关处方。与没有 CHD 的女性相比，患有 CHD 的女性总体上经历了更多的不良情况（aPR，1.9 [95%CI，1.7-2.1]），特别是产科（aPR，1.3 [95%CI，1.2-1.4]）和心脏疾病（aPR，10.2 [95%CI，9.1-11.4]）、死产（aPR，1.6 [95%CI，1.1-2.4]）和早产（aPR，1.6 [95%CI，1.4-1.8]）。与非严重 CHD 相比，更多严重 CHD 的女性总体上经历了不良情况（aPR，1.5 [95%CI，1.2-1.9]）。
结论 患有 CHD 的女性在妊娠期间心脏和产科不良情况的患病率较高；每 100 名女性中就有 4 名使用了潜在的致畸或胎儿毒性药物，只有一半接受了美国心脏协会推荐的全面超声心动图检查。
