Jonsson Sara, Johansson Bengt, Wikström Anna-Karin, Dahlqvist Jenny Alenius, Christersson Christina, Sörensson Peder, Trzebiatowska-Krzynska Aleksandra, Dellborg Mikael, Thilén Ulf, Sundström-Poromaa Inger, Bay Annika
Department of Public Health and Clinical Medicine, Umea University, 901 87 Umeå, Sweden.
Department of Diagnostics and Intervention, Umeå University, 901 87 Umeå, Sweden.
Eur Heart J Open. 2025 Jun 21;5(4):oeaf081. doi: 10.1093/ehjopen/oeaf081. eCollection 2025 Jul.
With a growing population of women with congenital heart disease (CHD), pregnancies in this group are expected to increase. However, pregnancy in women with CHD is associated with increased adverse outcomes for both mother and child. The aim of this study was to evaluate pregnancy and foetal complications in women with CHD and to test their association with the modified WHO (mWHO) classification.
Using two national registers, the national register for CHD and the Pregnancy Register, primiparous women giving birth between 2014 and 2019 were identified. Women with CHD, = 829, and women without CHD, = 4137, were matched by birth year and municipality in a ∼1:5 ratio. The women with CHD were classified according to the mWHO criteria. Caesarean deliveries (25.7 vs. 17.2%, < 0.001), preterm delivery (10.3 vs. 6.4%, < 0.001), and preeclampsia (6.2 vs. 4.1%, = 0.007) were more common in women with CHD compared with controls. Using logistic regression, there was an association between high mWHO class (mWHO III, IV) and caesarean section [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.8-6.7], preterm birth (<37 weeks) (OR 8.3, 95% CI 4.1-17.1), and preeclampsia (OR 3.8, 95% CI 1.5-9.9).
Pregnancy complications are more common in women with CHD. In women with CHD, the mWHO classification is associated with maternal complications and preterm birth. Thus, large national register data corroborate the advice provided in current guidelines, and the mWHO class is deemed a valuable risk stratification tool in women with CHD.
随着先天性心脏病（CHD）女性人口的增加，该群体的妊娠情况预计也会增多。然而，CHD女性妊娠与母婴不良结局增加相关。本研究的目的是评估CHD女性的妊娠及胎儿并发症，并检验它们与世界卫生组织修订版（mWHO）分类的相关性。
利用两个国家登记处，即CHD国家登记处和妊娠登记处，确定了2014年至2019年间分娩的初产妇。829例CHD女性和4137例非CHD女性按出生年份和直辖市以约1:5的比例进行匹配。CHD女性根据mWHO标准进行分类。与对照组相比，CHD女性剖宫产（25.7%对17.2%，P<0.001）、早产（10.3%对6.4%，P<0.001）和先兆子痫（6.2%对4.1%，P = 0.007）更为常见。使用逻辑回归分析，mWHO高分级（mWHO III、IV级）与剖宫产[比值比（OR）3.4，95%置信区间（CI）1.8 - 6.7]、早产（<37周）（OR 8.3，95%CI 4.1 - 17.1）和先兆子痫（OR 3.8，95%CI 1.5 - 9.9）之间存在关联。
CHD女性妊娠并发症更为常见。在CHD女性中，mWHO分类与母体并发症和早产相关。因此，大型国家登记数据证实了当前指南中的建议，mWHO分级被认为是CHD女性中一种有价值的风险分层工具。
