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Holstad Y, Johansson B, Lindqvist M, Westergren A, Sundström Poromaa I, Christersson C, Dellborg M, Trzebiatowska-Krzynska A, Sörensson P, Thilén U, Wikström AK, Bay A. Self-rated health in primiparous women with congenital heart disease before, during and after pregnancy - A register study. SCAND CARDIOVASC J 2024; 58:2295782. [PMID: 38130125 DOI: 10.1080/14017431.2023.2295782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
Background. Poor maternal self-rated health in healthy women is associated with adverse neonatal outcomes, but knowledge about self-rated health in pregnant women with congenital heart disease (CHD) is sparse. This study, therefore, investigated self-rated health before, during, and after pregnancy in women with CHD and factors associated with poor self-rated health. Methods. The Swedish national registers for CHD and pregnancy were merged and searched for primiparous women with data on self-rated health; 600 primiparous women with CHD and 3062 women in matched controls. Analysis was performed using descriptive statistics, chi-square test and logistic regression. Results. Women with CHD equally often rated their health as poor as the controls before (15.5% vs. 15.8%, p = .88), during (29.8% vs. 26.8% p = .13), and after pregnancy (18.8% vs. 17.6% p = .46). None of the factors related to heart disease were associated with poor self-rated health. Instead, factors associated with poor self-rated health during pregnancy in women with CHD were ≤12 years of education (OR 1.7, 95%CI 1.2-2.4) and self-reported history of psychiatric illness (OR 12.6, 95%CI 1.4-3.4). After pregnancy, solely self-reported history of psychiatric illness (OR 5.2, 95%CI 1.1-3.0) was associated with poor self-rated health. Conclusion. Women with CHD reported poor self-rated health comparable to controls before, during, and after pregnancy, and factors related to heart disease were not associated with poor self-rated health. Knowledge about self-rated health may guide professionals in reproductive counselling for women with CHD. Further research is required on how pregnancy affects self-rated health for the group in a long-term perspective.
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Affiliation(s)
- Ylva Holstad
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Bengt Johansson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Maria Lindqvist
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | | | | | | | - Mikael Dellborg
- Department of Clinical and Molecular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Peder Sörensson
- Department of Medicine, Solna, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Thilén
- Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Annika Bay
- Department of Nursing, Umeå University, Umeå, Sweden
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Bay A, Berghammer M, Burström Å, Holstad Y, Christersson C, Dellborg M, Trzebiatowska-Krzynska A, Sörensson P, Thilén U, Johansson B. Symptoms during pregnancy in primiparous women with congenital heart disease. SCAND CARDIOVASC J 2024; 58:2302135. [PMID: 38192047 DOI: 10.1080/14017431.2024.2302135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024]
Abstract
Background: As more women with congenital heart disease (CHD) are reaching childbearing age, it becomes more common for their symptoms to be evaluated during pregnancy. However, pregnancy-related symptoms are similar to those caused by heart disease. This study investigated the prevalence of factors associated with symptoms during pregnancy in women with CHD. Methods: The national birth register was searched for primiparous women with CHD who were registered in the national quality register for patients with CHD. Results: Symptoms during the third trimester were reported in 104 of 465 evaluated women. The most common symptom was palpitations followed by dyspnea. Factors associated with symptoms were tested in a univariable model; higher NYHA classification (>1) (OR 11.3, 95%CI 5.5-23.2), low physical activity (≤3 h/week) (OR 2.1 95%CI 1.3-3.6) and educational level ≤ 12 years (OR 1.9 95%CI 1.2-3.0) were associated with having symptoms. In multivariable analysis, low physical activity level (OR 2.4 95%CI 1.2-5.0) and higher NYHA class (OR 11.3 95%CI 5.0-25.6) remained associated with symptoms during pregnancy. There were no cases with new onset of impaired systemic ventricular function during pregnancy. Conclusion: Symptoms during pregnancy are common in women with CHD but are often already present before pregnancy. Because ordinary symptoms during pregnancy often overlap with symptoms of heart disease, it is important to know if symptoms were present before pregnancy and if they became worse during pregnancy. These results should be included in pre-pregnancy counselling and considered in the monitoring during pregnancy.
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Affiliation(s)
- Annika Bay
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Malin Berghammer
- Institute of Health Sciences, University West and Queen Silvia Children Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Burström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Holstad
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Peder Sörensson
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Thilén
- Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden
| | - Bengt Johansson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Rahnama N, Jemâa NB, Colson A, Pasquet A, de Castro LH, Debiève F, Pierard S. Pregnancy in women with congenital heart disease: New insights into neonatal risk prediction. Am Heart J 2024; 273:148-158. [PMID: 38679190 DOI: 10.1016/j.ahj.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Advances in managing adult congenital heart disease (ACHD) have led to an increased number of women with CHD reaching childbearing age. This demographic shift underscores the need for improved understanding and prediction of complications during pregnancy in this specific ACHD population. Despite progress in maternal cardiac risk assessment, the prediction of neonatal outcomes for ACHD pregnancies remains underdeveloped. Therefore, the aims of this study are to assess neonatal outcomes in a CHD women population, to identify their predictive factors and to propose a new risk score for predicting neonatal complications. METHODS This registry study included all women born between 1975 and 1996 diagnosed with ACHD who underwent at least one cardiology consultation for ACHD in Cliniques Universitaires Saint-Luc. A multivariate analysis was performed to identify predictors of neonatal complications and these were incorporated into a new risk index. Its validity was assessed using bootstrap method. This score was then compared with scores adapted from the ZAHARA and CARPREG studies for offspring events prediction. RESULTS Analysis of 491 pregnancies revealed 31.4% of neonatal complications. Four significant predictors of adverse neonatal outcomes were identified: cardiac treatment during pregnancy (OR 14.8, 95%CI [3.4-66]), hypertensive disorders of pregnancy (OR 11.4, 95%CI [3.4-39.0]), smoking during pregnancy (OR 10.6, 95%CI [2.8-40.6]), and pre-pregnancy BMI <18.5 kg/m² (OR 6.5, 95%CI [2.5-16.5]). The risk model demonstrated an AUC of 0.70 (95%CI [0.65-0.75]), which remained stable after bootstrap validation. This model significantly outperformed the scores adapted from ZAHARA and CARPREG data. Based on the regression coefficients, a risk score was subsequently developed comprising five risk categories. CONCLUSIONS One third of ACHD pregnancies are complicated by poor neonatal outcome. These complications are determined by four independent factors relating to the cardiac and non-cardiac status of the patients, which have been incorporated into a risk score. Our study is one of the first to propose a predictive risk score of neonatal outcomes in ACHD pregancies, and paves the way for other validation and confirmation studies.
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Affiliation(s)
- Nour Rahnama
- Cardiovascular Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Nour Ben Jemâa
- Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Arthur Colson
- Obstetrics Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Physiopathologie de la Reproduction (REPR), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Agnès Pasquet
- Cardiovascular Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | | | - Frédéric Debiève
- Obstetrics Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Physiopathologie de la Reproduction (REPR), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Sophie Pierard
- Cardiovascular Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium.
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Lin KM, Yang YH, Lee CP, Chen KJ, Yang YH, Sheen JM, Chien SJ. Maternal and neonatal outcomes in women with congenital heart disease: A nationwide population-based study. J Formos Med Assoc 2024; 123:744-750. [PMID: 38485554 DOI: 10.1016/j.jfma.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/30/2023] [Accepted: 11/20/2023] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND We evaluated the outcomes of pregnancy in women with congenital heart disease (CHD) and their offspring in Taiwan. We also investigated how different severity levels may influence the outcomes. METHODS We used data (2009-2017) from the Birth Certificate Application database in Taiwan, which is linked to the National Health Insurance Research Database and Taiwan Maternal and Child Health Database. We identified 2990 women with CHD who had 4227 births. Based on the CHD subtypes, patients were further divided into "severe CHD" and "simple CHD" groups. RESULTS Women with CHD have a significant risk of stillbirth. In maternal cardiac events, they had the highest risk of heart failure, followed by arrhythmia. The severity of CHD had a significant effect on the outcomes as well. The neonatal birth event that mothers with CHD have the highest risk of is preterm birth at < 32 weeks of gestation. The prominent difference in neonatal morbidities between mothers with severe and simple CHD is recurrent CHD in the offspring. The offspring of the severe CHD group had a higher risk of severe CHD, whereas those of the simple CHD group had a higher risk of simple CHD. CONCLUSION During pregnancy, the monitoring of heart function and cardiac rhythm could be more intensive in mothers with CHD. In addition to accurately assessing fetal growth and development during antenatal care, mothers with severe CHD should be provided with careful fetal heart structure assessment and genetic testing along with counseling.
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Affiliation(s)
- Kuan-Miao Lin
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Yun-Hsuan Yang
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Chuan-Pin Lee
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ko-Jung Chen
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi, Taiwan.
| | - Shao-Ju Chien
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Sandberg M, Fomina T, Macsali F, Greve G, Øyen N, Leirgul E. Preeclampsia and neonatal outcomes in pregnancies with maternal congenital heart disease: A nationwide cohort study from Norway. Acta Obstet Gynecol Scand 2024. [PMID: 38946266 DOI: 10.1111/aogs.14902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/30/2024] [Accepted: 06/10/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION The prevalence of congenital heart disease (CHD) among women of reproductive age is rising. We aimed to investigate the risk of preeclampsia and adverse neonatal outcomes in pregnancies of mothers with CHD compared to pregnancies of mothers without heart disease. MATERIAL AND METHODS In a nationwide cohort of pregnancies in Norway 1994-2014, we retrieved information on maternal heart disease, the course of pregnancy, and neonatal outcomes from national registries. Comparing pregnancies with maternal CHD to pregnancies without maternal heart disease, we used Cox regression to estimate the adjusted hazard ratio (aHR) for preeclampsia and log-binomial regression to estimate the adjusted risk ratio (aRR) for adverse neonatal outcomes. The estimates were adjusted for maternal age and year of childbirth and presented with 95% confidence intervals (CIs). RESULTS Among 1 218 452 pregnancies, 2425 had mild maternal CHD, and 603 had moderate/severe CHD. Compared to pregnancies without maternal heart disease, the risk of preeclampsia was increased in pregnancies with mild and moderate/severe maternal CHD (aHR1.37, 95% CI 1.14-1.65 and aHR 1.62, 95% CI 1.13-2.32). The risk of preterm birth was increased in pregnancies with mild maternal CHD (aRR 1.33, 95% CI 1.15-1.54) and further increased with moderate/severe CHD (aRR 2.49, 95% CI 2.03-3.07). Maternal CHD was associated with elevated risks of both spontaneous and iatrogenic preterm birth. The risk of infants small-for-gestational-age was slightly increased with mild maternal CHD (aRR 1.12, 95% CI 1.00-1.26) and increased with moderate/severe CHD (aRR 1.63, 95% CI 1.36-1.95). The prevalence of stillbirth was 3.9 per 1000 pregnancies without maternal heart disease, 5.6 per 1000 with mild maternal CHD, and 6.8 per 1000 with moderate/severe maternal CHD. Still, there were too few cases to report a significant difference. There were no maternal deaths in women with CHD. CONCLUSIONS Moderate/severe maternal CHD in pregnancy was associated with increased risks of preeclampsia, preterm birth, and infants small-for-gestational-age. Mild maternal CHD was associated with less increased risks. For women with moderate/severe CHD, their risk of preeclampsia and adverse neonatal outcomes should be evaluated together with their cardiac risk in pregnancy, and follow-up in pregnancy should be ascertained.
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Affiliation(s)
- Marit Sandberg
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Tatiana Fomina
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ferenc Macsali
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - Gottfried Greve
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Nina Øyen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Elisabeth Leirgul
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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6
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Jonsson S, Sundström-Poromaa I, Johansson B, Alenius Dahlqvist J, Christersson C, Dellborg M, Trzebiatowska-Krzynska A, Sörensson P, Thilén U, Wikström AK, Bay A. Time to childbirth and assisted reproductive treatment in women with congenital heart disease. Open Heart 2024; 11:e002591. [PMID: 38485120 PMCID: PMC10941114 DOI: 10.1136/openhrt-2023-002591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To investigate the time to first childbirth and to compare the prevalence of assisted reproductive treatment (ART) in women with congenital heart disease (CHD) compared with women without CHD. METHODS All women in the national register for CHD who had a registered first childbirth in the Swedish Pregnancy Register between 2014 and 2019 were identified. These individuals (cases) were matched by birth year and municipality to women without CHD (controls) in a 1:5 ratio. The time from the 18th birthday to the first childbirth and the prevalence of ART was compared between cases and controls. RESULTS 830 first childbirths in cases were identified and compared with 4137 controls. Cases were slightly older at the time for first childbirth (28.9 vs 28.5 years, p=0.04) and ART was more common (6.1% vs 4.0%, p<0.01) compared with controls. There were no differences in ART when stratifying for the complexity of CHD. For all women, higher age was associated with ART treatment (OR 1.24, 95% CI 1.20 to 1.28). CONCLUSIONS Women with and without CHD who gave birth to a first child did so at similar ages. ART was more common in women with CHD, but disease severity did not influence the need for ART. Age was an important risk factor for ART also in women with CHD and should be considered in consultations with these patients.
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Affiliation(s)
- Sara Jonsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Bengt Johansson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | | | | | - Mikael Dellborg
- Department of Clinical and Molecular Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | | | - Peder Sörensson
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Thilén
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna-Karin Wikström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Annika Bay
- Department of Nursing, Umeå University, Umeå, Sweden
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7
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Young BT, Baer RJ, Chambers CD, Peyvandi S, Jelliffe-Pawlowski LL, Steurer MA. What drives outcomes in infants of mothers with congenital heart disease? A mediation analysis. J Perinatol 2024; 44:366-372. [PMID: 37857810 PMCID: PMC10920192 DOI: 10.1038/s41372-023-01796-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Infants of mothers with adult congenital heart disease (ACHD) are at increased risk for adverse pregnancy and neonatal outcomes. We aim to identify mediators in the relationship between ACHD and pregnancy and infant outcomes. STUDY DESIGN Case-control study using linked maternal and infant hospital records. Structural equation modeling was performed to assess for potential mediators of pregnancy and infant outcomes. RESULT We showed an increased risk of multiple adverse infant and pregnancy outcomes among infants born to mothers with ACHD. Maternal placental syndrome and congestive heart failure were mediators of prematurity. Prematurity and critical congenital heart disease in the infant were mediators of infant outcomes. However, the direct effect of ACHD on outcomes beyond that explained by these mediators remained significant. CONCLUSION While significant mediators of infant and pregnancy outcomes were identified, there was a large direct effect of maternal ACHD. Further studies should aim to identify more factors that explain these infants' vulnerability.
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Affiliation(s)
- Brian T Young
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, US.
- Division of Pediatric Critical Care, Department of Pediatrics, Kaiser Permanente Northern California, Oakland, CA, US.
| | - Rebecca J Baer
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, US
- Department of Pediatrics, University of California San Diego, La Jolla, CA, US
| | | | - Shabnam Peyvandi
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, US
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, US
| | - Laura L Jelliffe-Pawlowski
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, US
| | - Martina A Steurer
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, US
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, US
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8
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Dong J, Hao T. Association of maternal and paternal risk factors with risk of congenital heart disease in infants: a case-control study. Ir J Med Sci 2024; 193:95-99. [PMID: 37249792 DOI: 10.1007/s11845-023-03409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE We aimed to explore maternal and paternal risk factors with risk of congenital heart disease in infants. METHODS A total of 125 congenital heart disease (CHD) infants and 125 controls were included in Heping Hospital Affiliated to Changzhi Medical College, Shanxi, China. Subjects were diagnosed between Jan 1, 2016 and Dec 31, 2021 in the present study. All the characteristics were collected with questionnaire by face-to-face interview, including maternal and paternal risk factors. Conditional logistic regression was conducted to explore the risk factors with risk of congenital heart disease in infants. RESULTS For maternal risk factors, we found that age, number of pregnancies, systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI) were risk factors for CHD infants, and the ORs (95%CIs) were 1.15 (1.06-1.23) for age, 1.13 (1.02-1.29) for SBP, 1.06 (1.02-1.18) for DBP, 1.22 (1.16-1.31) for BMI. Compared with one pregnancy, the ORs (95%CIs) were 1.17 (1.05-1.29) for two pregnancies and 1.25 (1.16-1.47) for more pregnancies. For paternal risk factors, we found that age (OR = 1.07, 95%CI = 1.01-1.19), smoking (OR = 1.11, 95%CI = 1.03-1.27), drinking (OR = 1.04, 95%CI = 1.02-1.19), and BMI (OR = 1.15, 95%CI = 1.03-1.28) were risk factors for CHD infants. CONCLUSION We found that age, number of pregnancies, SBP, DBP, and BMI are maternal risk factors for CHD infants. And age, smoking, drinking, and BMI are paternal risk factors for CHD infants.
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Affiliation(s)
- Jianxia Dong
- Department of Preventive Health Care, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Tianyou Hao
- Department of Preventive Health Care, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China.
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Jost E, Kosian P, Greiner GG, Icks A, Schmitz MT, Schmid M, Merz WM. Obstetric Medicine: the protocol for a prospective three-dimensional cohort study to assess maternity care for women with pre-existing conditions (ForMaT). Front Med (Lausanne) 2024; 10:1258716. [PMID: 38274449 PMCID: PMC10808351 DOI: 10.3389/fmed.2023.1258716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Background Pregnancies in women with pre-existing medical conditions are on the rise. These pregnancies are characterized by an increased rate of maternal and perinatal complications, which can result in higher health care expenditures and altered pregnancy experiences. The purpose of this study is to integrally analyze maternity care for women with pre-existing conditions in the framework of a risk-adapted, interdisciplinary care by recording three substantial parts of maternity care: (1) maternal and perinatal outcome; (2) hospital costs and reimbursements covering the period from preconception counseling or initial antenatal visit to discharge after birth; and (3) women's experience of reproductive choice and becoming a mother in the presence of a pre-existing condition. Methods In this observational, prospective, longitudinal, and monocentric cohort study, we aim to include a total of 1,500 women over a recruitment period of 15 months. Women registering for care at the Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Germany, are allocated to three groups based on their health and risk status: women with pre-existing conditions, as well as healthy women with obstetric risk factor and healthy women with a low-risk pregnancy. Participants are observed from time of initial consultation until discharge after birth. Analysis focuses on (1) maternal and perinatal outcome, especially rate of severe maternal and neonatal morbidity; (2) costs and reimbursements; and (3) surveys to capture of women's experience and health-related quality of life during the time of reproductive choice, pregnancy, and childbirth in the presence of pre-existing medical conditions. Discussion With its complex three-dimensional design, the ForMaT-Trial is aiming to provide a comprehensive analysis of pregnancy and childbirth in women with pre-existing conditions. The results may serve as a basis for counseling and care of these women. By analyzing costs of specialized care, data for discussing reimbursement are generated. Lastly, our results may increase awareness for the perception of reproductive choice, pregnancy and motherhood in this continuously rising population.Clinical trial registration: German Clinical Trials Register, DRKS00030061, October 28, 2022.
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Affiliation(s)
- Elena Jost
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Philipp Kosian
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Gregory Gordon Greiner
- Institute of Health Services Research and Health Economics, Faculty of Medicine, Center for Health and Society, Heinrich Heine University Düsseldorf and University Hospital, Düsseldorf, Germany
- Institute of Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research Germany, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Andrea Icks
- Institute of Health Services Research and Health Economics, Faculty of Medicine, Center for Health and Society, Heinrich Heine University Düsseldorf and University Hospital, Düsseldorf, Germany
- Institute of Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research Germany, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Waltraut M. Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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10
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Wedlund F, von Wowern E, Hlebowicz J. Increased cesarean section rate and premature birth according to modified WHO maternal cardiovascular risk in pregnant women with congenital heart disease. PLoS One 2023; 18:e0294323. [PMID: 37971983 PMCID: PMC10653484 DOI: 10.1371/journal.pone.0294323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND During pregnancy and delivery, hemodynamics are altered and complex congenital heart disease has been associated with adverse maternal and neonatal outcomes. We sought to investigate pregnancy outcome and complications in relation to complexity of heart condition. MATERIALS AND METHODS We studied women with ACHD discussed at multidisciplinary conferences at Lund University Hospital March 2009-May 2021. We studied 149 pregnancies in 101 women. We scored each woman retrospectively according to the modified World Health Organization (mWHO) risk classification and included patients in risk class I (n = 36, 24.1%), II (n = 43, 28.9%), II-III (n = 43, 28.9%), III (n = 24, 16.1%) and IV (n = 3, 2.0%). RESULTS Women with mWHO class ≥III underwent cesarean section more often than women in less complex mWHO classes, (OR, 5.1; 95% CI, 2.0-12.5; p<0.001). The odds of premature delivery were significantly higher among pregnant women with mWHO class ≥III (OR, 6.7; 95% CI, 2.6-17.4; p<0.001). We found no difference in incidence of preeclampsia, gestational hypertension, gestational diabetes, hemorrhage >1000 ml or cardiac defect in the neonate depending on WHO-class. Women in mWHO classes III-IV had a higher rate of fetal growth restriction (FGR) compared to women in mWHO classes I, II, II-III (p<0.007). CONCLUSIONS Our findings indicate that women with more complex heart disease (mWHO classes III or IV) tend to have a higher rate of cesarean section, premature birth and FGR.
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Affiliation(s)
- Frida Wedlund
- Department of Cardiology, Skåne University Hospital, Lund University, Malmö, Sweden
- Clinical Sciences, Lund University, Lund, Sweden
| | - Emma von Wowern
- Institution of Clinical Sciences Malmö, Perinatal and Cardiovascular Epidemiology, Lund University, Lund, Sweden
- Dept. of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Joanna Hlebowicz
- Clinical Sciences, Lund University, Lund, Sweden
- Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
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11
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Crea F. Hot topics in valvular heart disease: tricuspid regurgitation, bicuspid aortic valve, artificial intelligence for aortic stenosis, and aortic aneurysm. Eur Heart J 2023; 44:4493-4496. [PMID: 37963104 DOI: 10.1093/eurheartj/ehad743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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12
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Yellin S, Wiener S, Kankaria R, Vorawandthanachai T, Hsu D, Haberer K, Bortnick AE, Diana WS. Characteristics and outcomes of socioeconomically disadvantaged pregnant individuals with adult congenital heart disease presenting to a Cardio-Obstetrics Program. Am J Obstet Gynecol MFM 2023; 5:101146. [PMID: 37659603 PMCID: PMC11157696 DOI: 10.1016/j.ajogmf.2023.101146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/20/2023] [Accepted: 08/26/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Outcomes of individuals with adult congenital heart disease who are socioeconomically disadvantaged and cared for in cardio-obstetrical programs, are lacking. OBJECTIVE This study aimed to describe the clinical characteristics, maternal pregnancy outcomes, and contraceptive uptake in individuals with adult congenital heart disease in an urban cardio-obstetrical program. STUDY DESIGN Retrospective data were collected for individuals with adult congenital heart disease seen in the Maternal Fetal Medicine-Cardiology Joint Program at Montefiore Health System between 2015 and 2021 and compared using modified World Health Organization class I, II vs the modified World Health Organization class ≥II/III. RESULTS Over 90% of individuals with adult congenital heart disease were pregnant at the time of referral. Modified World Health Organization class I, II (n=77, 62.4% Black or Hispanic/Latina) had a total of 94 pregnancies and modified World Health Organization class ≥II/III (n=49, 49.0% Black or Hispanic/Latina) had a total of 56 pregnancies. Over 25% of individuals in each group had a body mass index ≥30 (P=.78), and very low summary socioeconomic scores. Modified World Health Organization class ≥II/III were more likely to be anticoagulated in the first trimester than modified World Health Organization class I, II (10.7% vs 0.0%, P=.002) and throughout pregnancy (14.3% vs 3.2% P=.02). Modified World Health Organization class ≥II/III were more likely to require arterial monitoring during delivery than modified World Health Organization class I, II (14.3% vs 0.0%, P=.001) or delivery under general anesthesia (8.9% vs 1.1%, P=.03) but had a comparable frequency of cesarean delivery (35.8% vs 41.3%, P=.68). There were no in-hospital maternal deaths. There was no difference in the type of contraception recommended by modified World Health Organization class, however, modified World Health Organization class ≥II/III were more likely to receive long-acting types or permanent sterilization (35.6% vs 54.6%, P=.045). CONCLUSION In a socioeconomically disadvantaged cohort with adult congenital heart disease from a historically marginalized community, those with modified World Health Organization class ≥II/III had more complex antepartum and intrapartum needs but similar maternal and obstetrical outcomes as modified World Health Organization class I, II. The multidisciplinary approach offered by a cardio-obstetrics program may contribute to successful outcomes in this high-risk cohort, and these data are hypothesis-generating.
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Affiliation(s)
- Shira Yellin
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana)
| | - Sara Wiener
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana)
| | - Rohan Kankaria
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana)
| | - Thammatat Vorawandthanachai
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana)
| | - Daphne Hsu
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana); Division of Pediatric Cardiology and Adult Congenital Heart Program, Department of Pediatrics, Children's Hospital at Montefiore Medical Center, Bronx, NY (Dr. Hsu and Dr. Haberer)
| | - Kim Haberer
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana); Division of Pediatric Cardiology and Adult Congenital Heart Program, Department of Pediatrics, Children's Hospital at Montefiore Medical Center, Bronx, NY (Dr. Hsu and Dr. Haberer)
| | - Anna E Bortnick
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana); Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana); Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana); Department of Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana)
| | - Wolfe S Diana
- Albert Einstein College of Medicine, Bronx, NY (Dr. Yellin, Dr. Wiener, Dr. Kankaria, Dr. Vorawandthanachai, Dr. Hsu, Dr. Haberer, Dr. Bortnick, and Dr. Diana); Division of Cardiology, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana); Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana); Department of Women's Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (Dr. Bortnick and Dr. Diana).
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13
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Rodriguez CP, Economy KE, Duarte VE, Mehta N, Duncan ME, Chandler S, Gauvreau K, Easter SR, Wu F, Lachtrupp C, Tedrow U, Valente AM, Tadros T. Mobile Cardiac Telemetry Use to Predict Adverse Pregnancy Outcomes in Patients With Congenital Heart Disease. JACC. ADVANCES 2023; 2:100593. [PMID: 38938332 PMCID: PMC11198184 DOI: 10.1016/j.jacadv.2023.100593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2024]
Abstract
Background Patients with congenital heart disease (CHD) have a higher incidence of arrhythmias during pregnancy, yet the utility of mobile cardiac telemetry (MCT) to predict adverse outcomes is unknown. Objectives The purpose of this study is to determine whether arrhythmias on screening MCT correlate with adverse pregnancy outcomes. Methods Patients with CHD prospectively enrolled in the Standardized Outcomes in Reproductive Cardiovascular Care initiative underwent 24-hour MCT (within 18 months prior to pregnancy). Positive findings on MCT were defined as episodes of bradyarrhythmia, symptomatic atrioventricular block, ectopic atrial or ventricular activity, and supraventricular or ventricular tachycardia. Clinically significant arrhythmia events (CSAEs) were those requiring medical or device intervention or an emergency room visit. Clinical events during the antepartum, intrapartum, and postpartum periods were compared using Fisher's exact test. Analyses were performed using Stata version 16. Results In 141 pregnancies in 118 patients with CHD, MCT detected positive findings in 17%. Adverse cardiac outcomes occurred in 11% of pregnancies, of which CSAE occurred in 3.5%. Positive MCT was significantly associated with subsequent CSAE (21% vs 0%, P < 0.001) and cumulative adverse maternal cardiac outcomes (33% vs 7%, P = 0.001) but did not correlate with obstetric (46% vs 41%, P = 0.660) or neonatal outcomes (33% vs 31%, P = 0.810). Of the patients with CSAE, 75% had ≥moderate CHD complexity. Conclusions Patients with CHD had a high rate of positive MCT findings. This was associated with CSAE and adverse maternal cardiac outcomes. Patients with ≥moderate CHD complexity may benefit from screening MCT to improve preconceptual counseling and planning.
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Affiliation(s)
- Carla P. Rodriguez
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine E. Economy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Valeria E. Duarte
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nishaki Mehta
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Madeline E. Duncan
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie Chandler
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Rae Easter
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Fred Wu
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cara Lachtrupp
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Usha Tedrow
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Marie Valente
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Tadros
- Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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14
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Uebing A, Hitz MP. How can we improve the evidence base for the treatment and care for patients with congenital heart disease? Eur Heart J 2023; 44:3261-3263. [PMID: 36747474 DOI: 10.1093/eurheartj/ehad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Anselm Uebing
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Arnold-Heller-Str. 3, D-24105 Kiel, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Kiel, Germany
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Marc-Phillip Hitz
- Department of Congenital Heart Disease and Paediatric Cardiology, University Hospital of Schleswig-Holstein, Arnold-Heller-Str. 3, D-24105 Kiel, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Kiel, Germany
- Competence Network for Congenital Heart Defects, Berlin, Germany
- Department for Medical Genetics, University of Oldenburg, Oldenburg, Germany
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15
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Venkatesh P, Lin JP, Nguyen A, Rezkalla J, Moore JP. Predictors of arrhythmia during pregnancy in adults with congenital heart disease. Int J Cardiol 2023; 386:37-44. [PMID: 37178799 DOI: 10.1016/j.ijcard.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Risk prediction of arrhythmia during pregnancy in adult congenital heart disease (ACHD) patients is currently lacking, and the impact of preconception catheter ablation on future antepartum arrhythmia has not been studied. METHODS We conducted a single-center, retrospective cohort study of pregnancies in ACHD patients. Clinically significant arrhythmia events during pregnancy were described, predictors of arrhythmia were analyzed, and a risk score devised. The impact of preconception catheter ablation on antepartum arrhythmia was assessed. RESULTS The study included 172 pregnancies in 137 patients. Arrhythmia events occurred in 25 (15%) of pregnancies, with 64% of events occurring in the second trimester and sustained supraventricular tachycardia being the most common rhythm. Univariate predictors of arrhythmia were history of tachyarrhythmia (OR 20.33, 95% CI 6.95-59.47, p < 0.001, Fontan circulation (OR 11.90, 95% CI 2.60-53.70, p < 0.001), baseline physiologic class C/D (OR 3.72, 95% CI 1.54-9.01, p = 0.002) and history of multiple valve interventions (OR 3.10, 95% CI 1.20-8.20, p = 0.017). Three risk factors (excluding multiple valve interventions) were used to formulate a risk score, with a cutoff of ≥2 points predicting antepartum arrhythmia with sensitivity and specificity of 84%. While recurrence of the index arrhythmia was not observed following successful catheter ablation, preconception ablation did not impact odds of antepartum arrhythmia. CONCLUSIONS We provide a novel risk stratification scheme for predicting antepartum arrhythmia in ACHD patients. The role of contemporary preconception catheter ablation in risk reduction needs further refinement with multicenter investigation.
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Affiliation(s)
- Prashanth Venkatesh
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Jeannette P Lin
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; UCLA Cardio-Obstetrics Program, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Amanda Nguyen
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Joshua Rezkalla
- Department of Cardiology, Mayo Clinic, Rochester, MN, United States of America
| | - Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; UCLA Cardiac Arrhythmia Center, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
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16
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Nehme L, Ye P, Huang JC, Kawakita T. Decision and economic analysis of hostile abortion laws compared with supportive abortion laws. Am J Obstet Gynecol MFM 2023; 5:101019. [PMID: 37178721 DOI: 10.1016/j.ajogmf.2023.101019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND On June 24, 2022, the US Supreme Court overturned Roe v Wade in Dobbs v Jackson Women's Health Organization. Therefore, several states banned abortion, and other states are considering more hostile abortion laws. OBJECTIVE This study aimed to assess the incidence of adverse maternal and neonatal outcomes in the hypothetical cohort where all states have hostile abortion laws compared with the pre-Dobbs v Jackson cohort (supportive abortion laws cohort) and examine the cost-effectiveness of these policies. STUDY DESIGN This study developed a decision and economic analysis model comparing the hostile abortion laws cohort with the supportive abortion laws cohort in a sample of 5.3 million pregnancies. Cost (inflated to 2022 US dollars) estimates were from a healthcare provider's perspective, including immediate and long-term costs. The time horizon was set to a lifetime. Probabilities, costs, and utilities were derived from the literature. The cost-effectiveness threshold was set to be at $100,000 per quality-adjusted life year. Probabilistic sensitivity analyses using the Monte Carlo simulation with 10,000 simulations were performed to assess the robustness of our results. The primary outcomes included maternal mortality and an incremental cost-effectiveness ratio. The secondary outcomes included hysterectomy, cesarean delivery, hospital readmission, neonatal intensive care unit admission, neonatal mortality, profound neurodevelopmental disability, and incremental cost and effectiveness. RESULTS In the base case analysis, the hostile abortion laws cohort had 12,911 more maternal mortalities, 7518 more hysterectomies, 234,376 more cesarean deliveries, 102,712 more hospital readmissions, 83,911 more neonatal intensive care unit admissions, 3311 more neonatal mortalities, and 904 more cases of profound neurodevelopmental disability than the supportive abortion laws cohort. The hostile abortion laws cohort was associated with more cost ($109.8 billion [hostile abortion laws cohort] vs $75.6 billion [supportive abortion laws cohort]) and 120,749,900 fewer quality-adjusted life years with an incremental cost-effectiveness ratio of negative $140,687.60 than the supportive abortion laws cohort. Probabilistic sensitivity analyses suggested that the chance of the supportive abortion laws cohort being the preferred strategy was more than 95%. CONCLUSION When states consider enacting hostile abortion laws, legislators should consider an increase in the incidence of adverse maternal and neonatal outcomes.
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Affiliation(s)
- Lea Nehme
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita)
| | - Peggy Ye
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC (Dr Ye); Georgetown University School of Medicine, Washington, DC (Dr Ye)
| | - Jim C Huang
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (Dr Huang)
| | - Tetsuya Kawakita
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Nehme and Kawakita).
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17
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Abdurrahman L. Women with congenital heart disease: Maternal and neonatal health. Curr Probl Pediatr Adolesc Health Care 2023:101398. [PMID: 37479598 DOI: 10.1016/j.cppeds.2023.101398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Lubabatu Abdurrahman
- Chief, Division of Cardiology, Dayton Children's Hospital, One Children's Plaza, Clinical Assistant Professor, Pediatrics, Wright State University, Boonshoft School of Medicine, Dayton, Ohio, 45404, USA.
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18
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Lee JS, Noh OK, Park JE. Neonatal Risk Factors for Growth Retardation in Infants With Congenital Heart Disease. J Korean Med Sci 2023; 38:e196. [PMID: 37401493 DOI: 10.3346/jkms.2023.38.e196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/13/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND While the association of congenital heart disease (CHD) and growth retardation (GR) is known, data remain limited. This study investigated the incidence of GR and its neonatal risk factors in patients with CHD using nationwide population-based claims data. METHOD The study population was extracted from Korean National Health Insurance Service claims data from January 2002 to December 2020. We included patients diagnosed with CHD under one year of age. GR was defined as an idiopathic growth hormone deficiency or short stature on the claims data. We investigated the neonatal risk factors for GR. RESULTS The number of patients diagnosed with CHD within the first year of birth was 133,739. Of these, 2,921 newborns were diagnosed with GR. The cumulative incidence of GR was 4.8% at 19 years of age for individuals diagnosed with CHD at infancy. In the multivariable analysis, the significant risk factors for GR were preterm birth, small for gestational age, low birth weight, respiratory distress, bronchopulmonary dysplasia, bacterial sepsis, necrotizing enterocolitis, feeding problems and cardiac procedure. CONCLUSION Several neonatal conditions were significant risk factors for GR in CHD patients, and appropriate monitoring and treatment programs are required in CHD neonates with these factors. Considering this study is limited to claims data, further studies are warranted, including genetic and environmental factors affecting GR in CHD patients.
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Affiliation(s)
- Jue Seong Lee
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Suwon, Korea.
| | - Jun Eun Park
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
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19
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Su Z, Zhang Y, Cai X, Li Q, Gu H, Luan Y, He Y, Li S, Chen J, Zhang H. Improving long-term care and outcomes of congenital heart disease: fulfilling the promise of a healthy life. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:502-518. [PMID: 37301214 DOI: 10.1016/s2352-4642(23)00053-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/16/2023] [Accepted: 02/28/2023] [Indexed: 06/12/2023]
Abstract
Advances in the prevention, diagnosis, and treatment for congenital heart disease (CHD), the most common birth defect in China, have drastically improved survival for individuals with the disease. However, China's current health system is not well prepared to manage the growing population of people with CHD and their complex medical needs, which range from early detection of the condition and intervention for physical, neurodevelopmental, and psychosocial impairment, to long-term management of major complications and chronic health problems. Health disparities caused by long-standing regional differences in access to care pose challenges when major complications such as pulmonary hypertension arise, and when individuals with complex CHD become pregnant and give birth. Currently, no data sources track neonates, children, adolescents, and adults with CHD in China and delineate their clinical characteristics and use of health resources. This scarcity of data should warrant attention from the Chinese Government and relevant specialists in the field. In the third paper of the Series on CHD in China, we summarise key literature and current data to identify knowledge gaps and call for concerted efforts by the government, hospitals, clinicians, industries, and charitable organisations to develop an actionable, lifelong framework of congenital cardiac care that is accessible and affordable for all individuals with CHD. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Zhanhao Su
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Department of Cardiovascular Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yunting Zhang
- Child Health Advocacy Institute, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoman Cai
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qiangqiang Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Yihua He
- Maternal-Fetal Medicine Centre in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing, China; Beijing Laboratory for Cardiovascular Precision Medicine, Beijing, China
| | - Shoujun Li
- Pediatric Cardiac Surgery Center and State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of South China, Structural Heart Disease, Guangzhou, China
| | - Hao Zhang
- Heart Center and Shanghai Institute of Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; Shanghai Clinical Research Center for Rare Pediatric Diseases, Shanghai Children's Medical Center, National Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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20
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Wander G, van der Zande JA, Patel RR, Johnson MR, Roos-Hesselink J. Pregnancy in women with congenital heart disease: a focus on management and preventing the risk of complications. Expert Rev Cardiovasc Ther 2023; 21:587-599. [PMID: 37470417 DOI: 10.1080/14779072.2023.2237886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Congenital heart disease (CHD) is the most common cardiac disorder in pregnancy in the western world (around 80%). Due to improvements in surgical interventions more women with CHD are surviving to adulthood and choosing to become pregnant. AREAS COVERED Preconception counseling, antenatal management of CHDs and strategies to prevent maternal and fetal complications.Preconception counseling should start early, before the transition to adult care and be offered to both men and women. It should include the choice of contraception, lifestyle modifications, pre-pregnancy optimization of cardiac state, the chance of the child inheriting a similar cardiac lesion, the risks to the mother, and long-term prognosis. Pregnancy induces marked physiological changes in the cardiovascular system that may precipitate cardiac complications. Risk stratification is based on the underlying cardiac disease and data from studies including CARPREG, ZAHARA, and ROPAC. EXPERT OPINION Women with left to right shunts, regurgitant lesions, and most corrected CHDs are at lower risk and can be managed in secondary care. Complex CHD, including systemic right ventricle need expert counseling in a tertiary center. Those with severe stenotic lesions, pulmonary artery hypertension, and Eisenmenger's syndrome should avoid pregnancy, be given effective contraception and managed in a tertiary center if pregnancy does happen.
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Affiliation(s)
- Gurleen Wander
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Johanna A van der Zande
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roshni R Patel
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Mark R Johnson
- Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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21
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Udholm LF, Ebdrup NH, Arendt LH, Knudsen UB, Hjortdal VE, Ramlau-Hansen CH. Congenital heart disease and the risk of impaired fertility: A Danish nationwide cohort study using time to pregnancy. Int J Cardiol 2023:S0167-5273(23)00573-9. [PMID: 37094718 DOI: 10.1016/j.ijcard.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/16/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND The number of women with congenital heart disease (CHD) becoming pregnant are increasing. Although menstrual irregularities appear to occur more often in these patients, knowledge on their fertility is limited. In this nationwide cohort study, we evaluated the risk of impaired fertility in women with CHD compared with unaffected women using time to pregnancy (TTP). METHODS The Danish National Birth Cohort (DNBC) of pregnant women constituted the study population. Information on TTP and use of medically assisted reproduction (MAR) treatment was reported at a first trimester interview. Women with CHD were identified by linkage to the Danish National Patient Registry. TTP was divided into three categories; 0-5 months, 6-12 months (i.e. subfertile), and > 12 months or use of MAR treatment (i.e. infertile). Relative risk ratios (RRR) for subfertility and infertility with 95% confidence intervals were estimated using multinomial logistic regression. RESULTS Among 93,832 pregnancies in 84,922 women, CHD was diagnosed in 333 women (0.4%), contributing with 360 pregnancies. The CHD was of simple complexity in 291 women (87.4%). No association was found between CHD and longer TTP (RRR of 1.02 (95% CI: 0.75-1.40) for subfertility, and RRR of 0.86 (95% CI: 0.61-1.20) for infertility). Similar was observed when comparing women with simple CHD and unaffected women. The number of women with complex CHD was too low for evaluation. CONCLUSIONS Women with CHD had no increased risk of impaired fertility, assessed by TTP, when compared with unaffected women. Separate analysis of women with complex CHD was hampered by low numbers.
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Affiliation(s)
- Louise F Udholm
- Department of Clinical Medicine, Copenhagen University, 2200 Copenhagen N, Denmark; Department of Cardiothoracic Surgery, Copenhagen University Hospital, 2100 Copenhagen, Denmark; Department of Public Health, Research Unit for Epidemiology, Aarhus University, 8000 Aarhus, Denmark.
| | - Ninna H Ebdrup
- Department of Obstetrics and Gynaecology, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Linn H Arendt
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, 8000 Aarhus, Denmark; Department of Obstetrics and Gynaecology, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Ulla B Knudsen
- Department of Obstetrics and Gynaecology, Horsens Regional Hospital, 8700 Horsens, Denmark; Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, 2100 Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, 2200 Copenhagen N, Denmark
| | - Cecilia H Ramlau-Hansen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, 8000 Aarhus, Denmark
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22
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Bredy C, Deville F, Huguet H, Picot MC, De La Villeon G, Abassi H, Avesani M, Begue L, Burlet G, Boulot P, Fuchs F, Amedro P. Which risk score best predicts cardiovascular outcome in pregnant women with congenital heart disease? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:177-183. [PMID: 35472215 DOI: 10.1093/ehjqcco/qcac019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/03/2022] [Accepted: 04/23/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Management of pregnancy and risk stratification in women with congenital heart diseases (CHD) are challenging, especially due to physiological haemodynamic modifications that inevitably occur during pregnancy. AIMS To compare the accuracy of the existing pregnancy cardiovascular risk scores in prediction of maternal complications during pregnancy in CHD patients. METHOD AND RESULTS From 2007 to 2018, all pregnant women with a CHD who delivered birth after 20 weeks of gestation were identified. The discriminating power and the accuracy of the five existing pregnancy cardiovascular risk scores [CARPREG, CARPREG II, HARRIS, ZAHARA risk scores, and modified WHO (mWHO)] were evaluated.Out of 104 pregnancies in 65 CHD patients, 29% experienced cardiovascular complications during pregnancy or post-partum. For the five scores, the observed rate of cardiovascular events was higher than the expected risk. The values of area under the ROC curve were 0.75 (0.62-0.88) for mWHO, 0.65 (0.53-0.77) for CARPREG II, 0.60 (0.40-0.80) for HARRIS, 0.59 (0.47-0.72) for ZAHARA, and 0.58 (0.43-0.73) for CARPREG. CONCLUSION The modified WHO classification appeared to better predict cardiovascular outcome in pregnant women with CHD than the four other existing risk scores.Clinical Trial Registration: Clinicaltrials.gov: NCT04221048.
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Affiliation(s)
- Charlene Bredy
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Fanny Deville
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Helena Huguet
- Epidemiology and Clinical Research Department, University Hospital, 34295 Montpellier, France
| | - Marie-Christine Picot
- Epidemiology and Clinical Research Department, University Hospital, 34295 Montpellier, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Hamouda Abassi
- Paediatric and Congenital Cardiology Department, M3C Regional Reference CHD Centre, University Hospital, 34295 Montpellier, France
| | - Martina Avesani
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, 33 604 Bordeaux, France
| | - Laetitia Begue
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Gilles Burlet
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Pierre Boulot
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Florent Fuchs
- Gynaecology and Obstetrics Department, University Hospital, 34295 Montpellier, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, Avenue de Magellan, 33 604 Bordeaux, France.,IHU Liryc, Electrophysiology and Heart Modelling Institute, INSERM 1045, Bordeaux University Foundation, Av. du Haut Lévêque, 33600 Pessac, France
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23
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Udholm LF, Arendt LH, Knudsen UB, Ramlau‐Hansen CH, Hjortdal VE. Congenital Heart Disease and Fertility: A Danish Nationwide Cohort Study Including Both Men and Women. J Am Heart Assoc 2023; 12:e027409. [PMID: 36648105 PMCID: PMC9939059 DOI: 10.1161/jaha.122.027409] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Despite an increasing number of patients with congenital heart disease (CHD) reaching reproductive age, the fertility of these patients remains undescribed. Therefore, the aim of the study was to evaluate the fertility in men and women with CHD by estimating the risk of infertility and comparing the birth rates, proportions of individuals becoming parents or remaining childless, and the number of children per parent with unaffected individuals. Methods and Results The study population consisted of individuals born between 1977 and 2000. Information on CHD, infertility, and live born children were obtained from the Danish health registries. Hazard ratios for infertility were analyzed using a Cox regression model. Differences of proportions and birth rates were calculated and compared between groups. Among 1 385 895 individuals, a total of 8679 (0.6%) were diagnosed with CHD. Men and women with simple or moderate CHD had no increased risk of infertility when compared with the reference population. Estimates for complex CHD groups were too imprecise for evaluation. Individuals with CHD were more often childless with consequently lower birth rates compared with unaffected individuals. However, those becoming parents had the same number of children as the reference population. Conclusions Men and women with simple or moderate CHD had the same risk of infertility as the reference population. Despite patients with CHD more often being childless, those becoming parents had the same number of children as parents without CHD. The current findings increase the knowledge regarding fertility in the CHD population.
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Affiliation(s)
- Louise F. Udholm
- Department of Cardiothoracic SurgeryCopenhagen University HospitalCopenhagenDenmark,Department of Clinical MedicineCopenhagen UniversityCopenhagenDenmark,Department of Public Health, Research Unit for EpidemiologyAarhus UniversityAarhusDenmark
| | - Linn H. Arendt
- Department of Public Health, Research Unit for EpidemiologyAarhus UniversityAarhusDenmark,Department of Obstetrics and GynaecologyHorsens Regional HospitalHorsensDenmark
| | - Ulla B. Knudsen
- Department of Obstetrics and GynaecologyHorsens Regional HospitalHorsensDenmark,Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | | | - Vibeke E. Hjortdal
- Department of Cardiothoracic SurgeryCopenhagen University HospitalCopenhagenDenmark,Department of Clinical MedicineCopenhagen UniversityCopenhagenDenmark
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24
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Lee JS, Choi ES, Hwang Y, Lee KS, Ahn KH. Preterm birth and maternal heart disease: A machine learning analysis using the Korean national health insurance database. PLoS One 2023; 18:e0283959. [PMID: 37000887 PMCID: PMC10065252 DOI: 10.1371/journal.pone.0283959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Maternal heart disease is suspected to affect preterm birth (PTB); however, validated studies on the association between maternal heart disease and PTB are still limited. This study aimed to build a prediction model for PTB using machine learning analysis and nationwide population data, and to investigate the association between various maternal heart diseases and PTB. METHODS A population-based, retrospective cohort study was conducted using data obtained from the Korea National Health Insurance claims database, that included 174,926 primiparous women aged 25-40 years who delivered in 2017. The random forest variable importance was used to identify the major determinants of PTB and test its associations with maternal heart diseases, i.e., arrhythmia, ischemic heart disease (IHD), cardiomyopathy, congestive heart failure, and congenital heart disease first diagnosed before or during pregnancy. RESULTS Among the study population, 12,701 women had PTB, and 12,234 women had at least one heart disease. The areas under the receiver-operating-characteristic curves of the random forest with oversampling data were within 88.53 to 95.31. The accuracy range was 89.59 to 95.22. The most critical variables for PTB were socioeconomic status and age. The random forest variable importance indicated the strong associations of PTB with arrhythmia and IHD among the maternal heart diseases. Within the arrhythmia group, atrial fibrillation/flutter was the most significant risk factor for PTB based on the Shapley additive explanation value. CONCLUSIONS Careful evaluation and management of maternal heart disease during pregnancy would help reduce PTB. Machine learning is an effective prediction model for PTB and the major predictors of PTB included maternal heart disease such as arrhythmia and IHD.
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Affiliation(s)
- Jue Seong Lee
- Department of Pediatric Cardiology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Eun-Saem Choi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Yujin Hwang
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
- AI Center, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Kwang-Sig Lee
- AI Center, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
- * E-mail: (KHA); (KSL)
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
- * E-mail: (KHA); (KSL)
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Crea F. Heart failure in cardio-oncology and adult congenital heart disease: new challenges and therapeutic targets. Eur Heart J 2022; 43:4443-4446. [PMID: 36335981 DOI: 10.1093/eurheartj/ehac621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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26
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Herrick N, Al-Rousan T, Rodriguez C, Lee JH, Valente AM, Stone J, Ramos G, Asante-Boateng B, El-Said H, Moceri-Casas M, Alshawabkeh L. Priorities and Understanding of Pregnancy Among Women With Congenital Heart Disease: A Mixed-Methods Study. JACC. ADVANCES 2022; 1:100112. [PMID: 38939700 PMCID: PMC11198376 DOI: 10.1016/j.jacadv.2022.100112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 06/29/2024]
Abstract
Background Many women with congenital heart disease (CHD) desire safe and successful pregnancies, but a significant proportion does not seek prepregnancy counseling. Objectives This study aims to distinguish the personal priorities and perceptions about pregnancy in this growing population. Methods Women aged 18 to 50 years with CHD were enrolled from 2 sites. Using a mixed-methods approach (Q-methodology), 179 participants sorted 23 statements representing a collection of views on pregnancy using priority forced ranking along a scale from "strongly agree" to "strongly disagree." Results Majority of women were between 25 and 29 years of age, had moderate or severely complex CHD, and were married. Five unique group identities were elucidated from patient responses. Group 1 was centered around a strong desire to start a family. Women in group 2 had significant anxiety, and their psychological wellbeing interfered with their decision to start a family. Women in group 3 were concerned about premature death; if they do have kids, they want to be alive to see them grow old. Women in group 4 had strong objections to termination. Group 5 valued health care engagement. Group identities were unrelated to CHD complexity and demographic factors such as age and marital status. Six differentiating statements were identified that help distinguish which group a woman aligns with. Conclusions Women with CHD have diverse priorities and values relating to pregnancy and heart disease. This study used a mixed-methods approach to provide a framework identifying several domains for targeted prepregnancy counseling in women with CHD.
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Affiliation(s)
- Nicole Herrick
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity, University of California-San Diego, San Diego, California, USA
| | - Carla Rodriguez
- Division of Cardiology, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ji Hae Lee
- Division of Cardiology, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Marie Valente
- Division of Cardiology, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jordan Stone
- Reproductive Medicine Department, University of California-San Diego, San Diego, California, USA
| | - Gladys Ramos
- Reproductive Medicine Department, University of California-San Diego, San Diego, California, USA
| | - Bendelyn Asante-Boateng
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| | - Howaida El-Said
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Maria Moceri-Casas
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
| | - Laith Alshawabkeh
- Adult Congenital Heart Disease Program, Division of Cardiovascular Medicine, University of California-San Diego, San Diego, California, USA
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Crea F. A focus on congenital heart disease and neonatal cardiac regeneration: an exciting future. Eur Heart J 2022; 43:2643-2646. [PMID: 35858679 DOI: 10.1093/eurheartj/ehac379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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28
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Crea F. New avenues in the prevention of sudden cardiac death. Eur Heart J 2022; 43:2083-2086. [PMID: 35667660 DOI: 10.1093/eurheartj/ehac277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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29
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Venkataramani R, Lewis AE, Santos JI, Dhondu HS, Ramakrishna H. Maternal and Fetal Outcomes in Adult Congenital Heart Disease. J Cardiothorac Vasc Anesth 2022; 36:3676-3684. [DOI: 10.1053/j.jvca.2022.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/11/2022]
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30
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Crea F. Hot topics in congenital heart disease and new insight into ventricular non-compaction. Eur Heart J 2021; 42:4197-4201. [PMID: 34724708 DOI: 10.1093/eurheartj/ehab746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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