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Obstetric outcome in women with congenital heart disease: A nationwide cohort in Sweden

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Titel: Obstetric outcome in women with congenital heart disease: A nationwide cohort in Sweden
Autoren: Wedlund, Frida, Widing, Ellen, von Wowern, Emma, Christensson, Christina, Lindstedt, Sandra, Sörensson, Peder, Trzebiatowska-Krzynska, Aleksandra, Mandalenakis, Zacharias, Bay, Annika, Johansson, Bengt, Hlebowicz, Joanna
Weitere Verfasser: Lund University, Faculty of Medicine, Faculty Office - BMC, The Education Office, Division of Course Administration for the Medical Programme, Teachers at the Medical Programme, Lunds universitet, Medicinska fakulteten, Kansli M, Utbildningsenheten, Avdelningen för läkarprogrammets kursadministration, Lärare vid läkarprogrammet, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Cardiology, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Kardiologi, Originator, Lund University, Profile areas and other strong research environments, Strategic research areas (SRA), EXODIAB: Excellence of Diabetes Research in Sweden, Lunds universitet, Profilområden och andra starka forskningsmiljöer, Strategiska forskningsområden (SFO), EXODIAB: Excellence of Diabetes Research in Sweden, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Malmö, Perinatal and cardiovascular epidemiology, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Malmö, Perinatal och kardiovaskulär epidemiologi, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Thoracic Surgery, Clinical and experimental lung transplantation, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Thoraxkirurgi, Klinisk och experimentell lungtransplantation, Originator, Lund University, Profile areas and other strong research environments, Other Strong Research Environments, LUCC: Lund University Cancer Centre, Lunds universitet, Profilområden och andra starka forskningsmiljöer, Övriga starka forskningsmiljöer, LUCC: Lunds universitets cancercentrum, Originator, Lund University, Faculty of Medicine, WCMM-Wallenberg Centre for Molecular Medicine, Lunds universitet, Medicinska fakulteten, WCMM- Wallenberg center för molekylär medicinsk forskning, Originator, Lund University, Profile areas and other strong research environments, Strategic research areas (SRA), StemTherapy: National Initiative on Stem Cells for Regenerative Therapy, Lunds universitet, Profilområden och andra starka forskningsmiljöer, Strategiska forskningsområden (SFO), StemTherapy: National Initiative on Stem Cells for Regenerative Therapy, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Thoracic Surgery, NPWT technology, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Thoraxkirurgi, NPWT teknologin, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Thoracic Surgery, DCD transplantation of lungs, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Thoraxkirurgi, DCD transplantation av lungor, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Thoracic Surgery, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Thoraxkirurgi, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Malmö, Cardiovascular Research - Immunity and Atherosclerosis, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Malmö, Kardiovaskulär forskning - immunitet och ateroskleros, Originator
Quelle: Acta Obstetricia et Gynecologica Scandinavica.
Schlagwörter: Medical and Health Sciences, Clinical Medicine, Cardiology and Cardiovascular Disease, Medicin och hälsovetenskap, Klinisk medicin, Kardiologi och kardiovaskulära sjukdomar, Gynaecology, Obstetrics and Reproductive Medicine, Gynekologi, obstetrik och reproduktionsmedicin
Beschreibung: INTRODUCTION: Survival and healthcare for patients with congenital heart disease have improved, and the number of pregnancies among women of childbearing age with congenital heart disease has increased. Our aim was to investigate obstetric outcomes in a large retrospective, national registry study of women with congenital heart disease compared to controls. MATERIAL AND METHODS: The study included women over 18 years of age from the Swedish Registry of Congenital Heart Disease. Each case was matched with 10 controls from Statistics Sweden, based on the mother's birth year and birth county and all were subsequently linked to the Swedish Medical Birth Register. We included 7998 pregnancies in women with congenital heart disease and 84 799 in controls during 1973-2020. RESULTS: The mean age at delivery for women with congenital heart disease and controls was 28.7 (±5.0) and 28.7 (±5.1) years, respectively. Women with congenital heart disease smoked less, had a shorter gestation and a higher incidence of delivery by Cesarean section compared to controls. The likelihood of Cesarean section was increased in women with congenital heart disease compared to controls: odds ratio 1.45 (95% confidence interval (CI) 1.37-1.54). Compared to controls, women with congenital heart disease had an increased likelihood of giving birth to small-for-gestational-age neonates: odds ratio 1.40 (95% CI 1.23-1.58). The association regarding small-for-gestational-age remained after adjusting for body mass index, age, smoking, comorbid diseases and preeclampsia. Women with congenital heart disease had an increased likelihood of prematurity compared to controls: odds ratio 1.47 (95% CI 1.35-1.59). The likelihood of Cesarean section, small-for-gestational-age neonates and prematurity was higher in women with severe congenital heart disease than mild/moderate congenital heart disease, both compared to controls. CONCLUSIONS: In this large national case-control study in women with congenital heart disease, we showed an increased likelihood of giving birth prematurely by Cesarean section, and having a small-for-gestational-age neonate compared to matched controls. The likelihood seems even higher in women with severe congenital heart disease. Further research is needed to explore the underlying reasons for the high rates of Cesarean section in women with congenital heart disease.
Zugangs-URL: https://doi.org/10.1111/aogs.70093
Datenbank: SwePub
Beschreibung
Abstract:INTRODUCTION: Survival and healthcare for patients with congenital heart disease have improved, and the number of pregnancies among women of childbearing age with congenital heart disease has increased. Our aim was to investigate obstetric outcomes in a large retrospective, national registry study of women with congenital heart disease compared to controls. MATERIAL AND METHODS: The study included women over 18 years of age from the Swedish Registry of Congenital Heart Disease. Each case was matched with 10 controls from Statistics Sweden, based on the mother's birth year and birth county and all were subsequently linked to the Swedish Medical Birth Register. We included 7998 pregnancies in women with congenital heart disease and 84 799 in controls during 1973-2020. RESULTS: The mean age at delivery for women with congenital heart disease and controls was 28.7 (±5.0) and 28.7 (±5.1) years, respectively. Women with congenital heart disease smoked less, had a shorter gestation and a higher incidence of delivery by Cesarean section compared to controls. The likelihood of Cesarean section was increased in women with congenital heart disease compared to controls: odds ratio 1.45 (95% confidence interval (CI) 1.37-1.54). Compared to controls, women with congenital heart disease had an increased likelihood of giving birth to small-for-gestational-age neonates: odds ratio 1.40 (95% CI 1.23-1.58). The association regarding small-for-gestational-age remained after adjusting for body mass index, age, smoking, comorbid diseases and preeclampsia. Women with congenital heart disease had an increased likelihood of prematurity compared to controls: odds ratio 1.47 (95% CI 1.35-1.59). The likelihood of Cesarean section, small-for-gestational-age neonates and prematurity was higher in women with severe congenital heart disease than mild/moderate congenital heart disease, both compared to controls. CONCLUSIONS: In this large national case-control study in women with congenital heart disease, we showed an increased likelihood of giving birth prematurely by Cesarean section, and having a small-for-gestational-age neonate compared to matched controls. The likelihood seems even higher in women with severe congenital heart disease. Further research is needed to explore the underlying reasons for the high rates of Cesarean section in women with congenital heart disease.
ISSN:16000412
DOI:10.1111/aogs.70093