Objective: To evaluate pregnancy-related hospitalizations of women with congenital heart disease (CHD) in California
Background: It is recommended that women with complex CHD receive specialty care during pregnancy. There is a perception that these women require cesarean section (CS) for cardiac reasons, but hemodynamic changes are often less with a vaginal delivery. There are no population based studies evaluating pregnancy in CHD.
Methods: California hospital discharge data from the years 2000–2003 were analyzed. Subjects were chosen by age (12–44 years), diagnosis code for CHD and diagnosis or procedure code related to pregnancy. Among the hospitals, there were 7 self-identified specialized adult CHD centers. Descriptive statistics were used to characterize the population by age, CHD diagnosis (complex or non-complex), insurance, hospital (adult CHD center or not), and outcome (delivery, ante-partum, post-partum condition). Multivariate regression was used to determine predictors for CS.
Results: There were 1032 hospitalizations among women age 14–44 years (mean 27.7 years). Hospitalizations occurred at 210 different hospitals, with only 14% at the 7 adult CHD centers. CHD diagnoses were complex in 52% and non-complex in 48%. Among the hospitalization outcomes, 77% were deliveries (66% vaginal, 34% CS), 2% abortive and 21% ante or post partum conditions. CS rates were not statistically different between CHD centers (32%) and non-centers (34%) but were higher than the general population (21%). Women with complex CHD were more likely to have a CS (p=0.005) or an abortive outcome (p<0.001) than those with non-complex CHD. Women with complex CHD were less likely to have a CS at an adult CHD center than those women delivered at non-CHD centers (p=0.005). In regression analyses, complex CHD was the only variable associated with CS.
Conclusion: Most data on pregnancy in CHD are from single center studies, however, the majority of women with CHD delivered at non-CHD centers. Overall pregnancy outcomes did not appear different by hospital type, but the rates of CS in women with complex CHD suggests specialty care may affect mode of delivery. Understanding of the outcomes of pregnancy in women with CHD would be enhanced by detailed population-based studies.
TIMING AND MODE OF DELIVERY IN PRENATALLY DIAGNOSED CRITICAL CONGENITAL HEART DISEASE: AN ANALYSIS OF PRACTICES WITHIN THE UNIVERSITY OF CALIFORNIA FETAL CONSORTIUM