Complication Risks During Delivery Low for Pregnant Women with CHD

Chicago—Labor, delivery, and the postpartum period are a time of increased arrhythmia and congestive heart failure (CHF) incidence. Previous research has shown that childbirth is a time of increased risk for complications in women with congenital heart disease (CHD), but little is known about what those cardiovascular risks might be.

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New research presented at the AHA meeting found that pregnant women with CHD had very low risks of irregular heartbeat or other heart-related complications during labor and delivery; however, these women are more likely to undergo cesarean section delivery and remain in the hospital longer.

“We are pleased to find the risk of complications are not as high as expected in women with [CHD],” said the study’s lead author, Robert M. Hayward, MD, cardiac electrophysiology fellow, University of California, San Francisco, in a press statement.

Using real-world data from the Healthcare Cost and Utilization Project, the researchers identified admissions for vaginal and cesarean delivery in California hospitals between January 1, 2005, and December 31, 2011. They compared the length of stay, in-hospital mortality, incident of CHF, cardiac arrest, and incident of arrhythmias for women without CHD versus women with noncomplex CHD and complex CHD. The researchers analyzed the medical records of 2,720,980 women who delivered babies resulting in 2,770,382 live births. Among this group, 3218 women had noncomplex CHD and 248 women had complex CHD whose conditions were more advanced and had likely warranted surgical treatment during early childhood.

The results showed that a history of CHF was more common in women with complex CHD (8.1%) versus women with noncomplex CHD (2.6%) and women without CHD (0.08%). Those with CHD were more likely to undergo cesarean section delivery compared with women with noncomplex CHD and women without CHD (47% vs 40% and 33%, respectively). Furthermore, women with complex CHD remained in the hospital an average of 5 days compared with women with noncomplex CHD (3.4 days) and women without CHD (2.6 days). The incidence of in-hospital mortality was not significantly higher in women with CHD.

Reports of heart failure, arrhythmias, and cardiac arrest were uncommon for all 3 groups. When these women were followed for 1 year for repeat hospitalization, the medical records indicated that readmission at 30 days was more common in women with noncomplex CHD (4.1%) and complex CHD (2.7%) compared with women without CHD (1.1%). At 1 year, the in-hospital mortality and arrhythmias were more common in women with noncomplex CHD and complex CHD, but the incidence rates were low.—Eileen Koutnik-Fotopoulos