Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, CA, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):9991-10000. doi: 10.1080/14767058.2022.2081803. Epub 2022 Jun 5.
To characterize temporal trends and outcomes of delivery hospitalization with maternal congenital heart disease (CHD).
For this repeated cross-sectional analysis, deliveries to women aged 15-54 years with maternal CHD were identified in the 2000-2018 National Inpatient Sample. Temporal trends in maternal CHD were analyzed using joinpoint regression to estimate the average annual percentage change (AAPC) with 95% CIs. The relationship between maternal CHD and several adverse maternal outcomes was analyzed with log-linear regression models. Risk for adverse outcomes in the setting of maternal CHD was further characterized based on additional diagnoses of cardiac comorbidity including congestive heart failure, arrhythmia, valvular disease, pulmonary disorders, and history of thromboembolism.
Of 73,109,790 delivery hospitalizations, 51,841 had a diagnosis of maternal CHD (7.1 per 10,000). Maternal CHD rose from 4.2 to 10.9 per 10,000 deliveries (AAPC 4.8%, 95% CI 4.2%, 5.4%). Maternal CHD deliveries with a cardiac comorbidity diagnosis also increased from 0.6 to 2.6 per 10,000 from 2000 to 2018 (AAPC 8.4%, 95% CI 6.3%, 10.6%). Maternal CHD was associated with severe maternal morbidity (adjusted risk ratios [aRR] 4.97, 95% CI 4.75, 5.20), cardiac severe maternal morbidity (aRR 7.65, 95% CI 7.14, 8.19), placental abruption (aRR 1.30, 95% 1.21, 1.38), preterm delivery (aRR 1.47, 95% CI 1.43, 1.51), and transfusion (aRR 2.28, 95% CI 2.14, 2.42). Risk for severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) and cardiac severe morbidity (AAPC 4.7%, 95% CI 2.5%, 6.9%) increased significantly among women with maternal CHD over the study period. The presence of cardiac comorbidity diagnoses was associated with further increased risk.
Maternal CHD is becoming more common among US deliveries. Among deliveries with maternal CHD, risk for severe morbidity is increasing. These findings support that an increasing burden of risk from maternal CHD in the obstetric population.
描述先天性心脏病（CHD）产妇分娩住院的时间趋势和结局。
在这项重复的横断面分析中，从 2000 年至 2018 年国家住院患者样本中确定了患有先天性心脏病的 15-54 岁产妇的分娩情况。使用连接点回归分析来分析先天性心脏病产妇的时间趋势，以估计平均年百分比变化（AAPC）及其 95%置信区间（CI）。使用对数线性回归模型分析了先天性心脏病产妇与几种不良产妇结局之间的关系。根据充血性心力衰竭、心律失常、瓣膜疾病、肺部疾病和血栓栓塞史等心脏合并症的其他诊断，进一步描述了先天性心脏病产妇不良结局的风险。
在 73109790 例分娩住院中，有 51841 例诊断为先天性心脏病（每 10000 例中有 7.1 例）。先天性心脏病从每 10000 例分娩的 4.2 例增加到 10.9 例（AAPC 为 4.8%，95%CI 为 4.2%至 5.4%）。患有心脏合并症诊断的先天性心脏病产妇分娩也从 2000 年的每 10000 例分娩 0.6 例增加到 2018 年的 2.6 例（AAPC 为 8.4%，95%CI 为 6.3%至 10.6%）。先天性心脏病与严重产妇发病率（调整风险比[aRR]4.97，95%CI 4.75，5.20）、心脏严重产妇发病率（aRR 7.65，95%CI 7.14，8.19）、胎盘早剥（aRR 1.30，95%CI 1.21，1.38）、早产（aRR 1.47，95%CI 1.43，1.51）和输血（aRR 2.28，95%CI 2.14，2.42）相关。严重发病率（AAPC 为 4.7%，95%CI 为 2.5%至 6.9%）和心脏严重发病率（AAPC 为 4.7%，95%CI 为 2.5%至 6.9%）在研究期间，患有先天性心脏病的产妇中显著增加。心脏合并症诊断的存在与进一步增加的风险相关。
先天性心脏病在美国分娩中越来越常见。在患有先天性心脏病的产妇分娩中，严重发病率的风险正在增加。这些发现支持先天性心脏病在产科人群中风险负担不断增加的观点。
