Maternal, perinatal and post-neonatal outcomes in women with chronic heart disease in Washington State

Abstract

University of Washington Abstract Maternal, perinatal and post-neonatal outcomes in women with chronic heart disease in Washington State Peter J Leary Chair of the Supervisory Committee: Professor Noel Weiss Department of Epidemiology Objective: European and British reports suggest that the prevalence of maternal heart disease is increasing. The consequences of maternal congenital heart disease, ischemic heart disease, heart failure and pulmonary hypertension on the health of offspring are understudied. We explored the association between the presence of maternal heart disease and maternal, perinatal and infant outcomes. Methods: We conducted a population-based retrospective cohort study using Washington State birth certificates linked with hospital discharge records of mothers for whom the presence of maternal congenital heart disease, ischemic heart disease, heart failure or pulmonary hypertension was noted. Women who gave birth between 1987 and 2009 (n=2,171) were compared to a sample of mothers without these conditions (n=21,710), frequency matched by calendar year. We described the characteristics of pregnant women with heart disease over time. Logistic regression was used to describe the association between reported chronic maternal heart disease and small for gestational age (SGA) birth, as well as perinatal, post-neonatal and maternal death. Results: The proportion of births to women with reported heart disease increased 224% between the 1987-1994 and 2002-2009 calendar periods. Chronic maternal heart disease was associated with increased risk of SGA birth (OR 1.7, 95% CI 1.5-1.9), perinatal death (OR 2.5, 95% CI 1.8-3.5), post-neonatal death (OR 4.6, 95% CI 2.4-8.9) and maternal death (OR 55, 95% CI 12-249). Associations were similar among types of cardiac disease. Conclusion: The presence of chronic maternal heart disease is associated with elevated risk for poor maternal, perinatal and post-neonatal outcomes.