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Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease

2019; Wiley; Volume: 14; Issue: 5 Linguagem: Inglês

10.1111/chd.12811

1747-0803

Natalie Bottega, Isabelle Malhamé, Liming Guo, Raluca Ionescu‐Ittu, Judith Therrien, Ariane Marelli,

Cardiac Structural Anomalies and Repair

Congenital Heart DiseaseVolume 14, Issue 5 p. 735-744 ORIGINAL ARTICLE Secular trends in pregnancy rates, delivery outcomes, and related health care utilization among women with congenital heart disease Natalie Bottega MD, Natalie Bottega MD McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Quebec, CanadaSearch for more papers by this authorIsabelle Malhamé MD, MSc, FRCPC, Isabelle Malhamé MD, MSc, FRCPC orcid.org/0000-0002-9140-8735 Department of Medicine, Women and Infants Hospital, Providence, Rhode IslandSearch for more papers by this authorLiming Guo MD, MSc, Liming Guo MD, MSc McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Quebec, CanadaSearch for more papers by this authorRaluca Ionescu-Ittu MSc, PhD, Raluca Ionescu-Ittu MSc, PhD McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Quebec, CanadaSearch for more papers by this authorJudith Therrien MD, Judith Therrien MD McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Quebec, CanadaSearch for more papers by this authorAriane Marelli MD, MPH, FRCPC, FACC, FAHA, Corresponding Author Ariane Marelli MD, MPH, FRCPC, FACC, FAHA ariane.marelli@mcgill.ca McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Quebec, Canada Correspondence Ariane Marelli MD, MPH, FRCPC, FACC, FAHA, Faculty of Medicine, McGill Adult Unit for Congenital Heart Disease, Cardiology, McGill University Health Centre, McGill University, D055108, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada. Email: ariane.marelli@mcgill.caSearch for more papers by this author Natalie Bottega MD, Natalie Bottega MD McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Quebec, CanadaSearch for more papers by this authorIsabelle Malhamé MD, MSc, FRCPC, Isabelle Malhamé MD, MSc, FRCPC orcid.org/0000-0002-9140-8735 Department of Medicine, Women and Infants Hospital, Providence, Rhode IslandSearch for more papers by this authorLiming Guo MD, MSc, Liming Guo MD, MSc McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Quebec, CanadaSearch for more papers by this authorRaluca Ionescu-Ittu MSc, PhD, Raluca Ionescu-Ittu MSc, PhD McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Quebec, CanadaSearch for more papers by this authorJudith Therrien MD, Judith Therrien MD McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Quebec, CanadaSearch for more papers by this authorAriane Marelli MD, MPH, FRCPC, FACC, FAHA, Corresponding Author Ariane Marelli MD, MPH, FRCPC, FACC, FAHA ariane.marelli@mcgill.ca McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, Montreal, Quebec, Canada Correspondence Ariane Marelli MD, MPH, FRCPC, FACC, FAHA, Faculty of Medicine, McGill Adult Unit for Congenital Heart Disease, Cardiology, McGill University Health Centre, McGill University, D055108, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada. Email: ariane.marelli@mcgill.caSearch for more papers by this author First published: 17 June 2019 https://doi.org/10.1111/chd.12811Citations: 12 Funding information Dr. Marelli is supported by the Heart and Stroke Foundation of Quebec, the Fonds de Recherche en Santé Quebec and the Canadian Institute of Health Research Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Background The number of women with congenital heart disease (CHD) of reproductive age is increasing, yet a description of trends in pregnancy and delivery outcomes in this population is lacking. Objective To assess secular trends in pregnancy rates, delivery outcomes, and related health care utilization in the adult female CHD population in Quebec, Canada. Methods The Quebec CHD database was used to construct a cohort with all women with CHD aged 18-45 years between 1992 and 2004. Pregnancy and delivery rates were determined yearly and compared to the general population. Secular trends in pregnancy and delivery rates were assessed with linear regression. The cesarean delivery rate in the CHD population was compared to the general population. Predictors of cesarean section were determined with multivariable logistic regression. Cox regression, adjusted for comorbidities, was used to analyze the impact of cesarean sections on 1-year health care use following delivery. Results About 14 878 women were included. A total of 10 809 pregnancies were identified in 5641 women, of whom 4551 (80%) and 2528 (45%) experienced at least one delivery and/or abortion, respectively. Absolute yearly numbers and rates of pregnancies and deliveries increased during the study period (P < .05). The increment in cesarean section rates was more pronounced among women with CHD than among the general population. Gestational diabetes (OR 1.50, 95% CI [1.13, 1.99]), gestational hypertension (OR 1.81, 95% CI [1.27, 2.57]), and preeclampsia (OR 1.59, 95% CI [1.11, 2.8]) were independent predictors of cesarean delivery. Cesarean sections were associated with postpartum cardiac-hospitalization within 1 year following delivery (HR = 2.35, 95% CI [1.05, 5.28]). Conclusions Yearly numbers and rates of pregnancies and deliveries in adult females with CHD rose significantly during the study period. Cesarean sections led to increased health care utilization. Further research is required to determine causes of high cesarean section rates in this patient population. CONFLICT OF INTEREST None. Citing Literature Supporting Information Filename Description chd12811-sup-0001-TableS1-S3.docxapplication/docx, 19 KB Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Volume14, Issue5September/October 2019Pages 735-744 RelatedInformation