Obstetric Outcomes Associated with Fetal Cyanotic Congenital Heart Disease

Robert M. Rossi; Allison Divanovic; Emily A. DeFranco

doi:10.1055/s-0038-1673652

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(07): 701-708
DOI: 10.1055/s-0038-1673652

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Obstetric Outcomes Associated with Fetal Cyanotic Congenital Heart Disease

Robert M. Rossi

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio

²Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

,

Allison Divanovic

³Fetal Heart Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

,

Emily A. DeFranco

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio

²Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

› Author Affiliations

Abstract

Objective To characterize obstetric outcomes associated with cyanotic congenital heart disease (CCHD) in a contemporary population.

Study Design We conducted a population-based retrospective cohort study of all livebirths in Ohio (2006–2015). Obstetric characteristics of pregnancies complicated by fetal CCHD were compared with those without CCHD, excluding those with other anomalies and aneuploidy. The primary objective was to determine the risk of cesarean delivery among CCHD affected pregnancies. Multivariate logistic regression estimated the influence of CCHD on these obstetric outcomes.

Results Among 1,463,506 live births in Ohio, there were 863 (0.06%) CCHD affected births. The overall cesarean rate was 45.9 versus 31.0% (p< 0.001) in CCHD compared with non-CCHD pregnancies. After adjusting for various confounders, CCHD affected pregnancies were associated with a higher risk for cesarean delivery (adjusted relative risk [aRR]: 2.0, 95% confidence interval [CI]: 1.6–2.4), preterm birth (PTB) (aRR: 1.5, 95% CI: 1.1–2.0), induction of labor (aRR: 1.2, 95% CI: 1.04–1.4), small for gestational age (SGA) birthweight (aRR: 2.4, 95% CI: 2.0–2.9), and fetal intolerance of labor (FIOL; aRR: 2.0, 95% CI: 1.6–2.4). Women with CCHD affected pregnancies were also less likely to undergo a trial of labor (aRR: 0.4, 95% CI: 0.3–0.5) prior to cesarean delivery.

Conclusion Obstetric outcomes associated with CCHD include higher risk for cesarean delivery, PTB, SGA, and FIOL.

Keywords

congenital heart disease - cesarean - cyanotic - mode of delivery

Full Text

References

References
1 Allan LD, Sharland GK, Milburn A. , et al. Prospective diagnosis of 1,006 consecutive cases of congenital heart disease in the fetus. J Am Coll Cardiol 1994; 23 (06) 1452-1458
2 Brown KL, Ridout DA, Hoskote A, Verhulst L, Ricci M, Bull C. Delayed diagnosis of congenital heart disease worsens preoperative condition and outcome of surgery in neonates. Heart 2006; 92 (09) 1298-1302
3 Eapen RS, Rowland DG, Franklin WH. Effect of prenatal diagnosis of critical left heart obstruction on perinatal morbidity and mortality. Am J Perinatol 1998; 15 (04) 237-242
4 Mahle WT, Clancy RR, McGaurn SP, Goin JE, Clark BJ. Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics 2001; 107 (06) 1277-1282
5 Sivarajan V, Penny DJ, Filan P, Brizard C, Shekerdemian LS. Impact of antenatal diagnosis of hypoplastic left heart syndrome on the clinical presentation and surgical outcomes: the Australian experience. J Paediatr Child Health 2009; 45 (03) 112-117
6 Verheijen PM, Lisowski LA, Stoutenbeek P. , et al. Prenatal diagnosis of congenital heart disease affects preoperative acidosis in the newborn patient. J Thorac Cardiovasc Surg 2001; 121 (04) 798-803
7 Tzifa A, Barker C, Tibby SM, Simpson JM. Prenatal diagnosis of pulmonary atresia: impact on clinical presentation and early outcome. Arch Dis Child Fetal Neonatal Ed 2007; 92 (03) F199 –F203
8 Landis BJ, Levey A, Levasseur SM. , et al. Prenatal diagnosis of congenital heart disease and birth outcomes. Pediatr Cardiol 2013; 34 (03) 597-605
9 Cedergren MI, Källén BA. Obstetric outcome of 6346 pregnancies with infants affected by congenital heart defects. Eur J Obstet Gynecol Reprod Biol 2006; 125 (02) 211-216
10 National Center for Health Statistics. 2003 Revisions of the U.S. Standard Certificates of Live Birth. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/nchs/data/dvs/birth11-03final-ACC.pdf . Accessed August 2016
11 National Center for Health Statistics. Guide to completing the facility worksheets for the certificate of live birth and report of fetal death (2003 revision). Hyattsville, MD: 2012
12 Reporting newborn screening for critical congenital heart disease (CCHD) results to the Ohio Department of Health. Ohio Department of Health. Anna Starr. Available at: https://www.odh.ohio.gov/odhprograms/cmh/cwmh/CCHD/Critical%20Congenital%20Heart%20Disease.aspx . Accessed August 8, 2017
13 Martin JA, Osterman MJ, Kirmeyer SE, Gregory EC. Measuring gestational age in vital statistics data: transitioning to the obstetric estimate. Natl Vital Stat Rep 2015; 64 (05) 1-20
14 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87 (02) 163-168
15 Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894 i–xii, 1-253
16 Szklo M, Nieto F. Identifying noncausal associations: confounding. Epidemiology: Beyond the Basics. Burlington, MA: Jones & Bartlett Learning; 2014. :159–160
17 Levi S, Zhang WH, Alexander S, Viart P, Grandjean H. ; Eurofetus study group Short-term outcome of isolated and associated congenital heart defects in relation to antenatal ultrasound screening. Ultrasound Obstet Gynecol 2003; 21 (06) 532-538
18 Quartermain MD, Pasquali SK, Hill KD. , et al. Variation in prenatal diagnosis of congenital heart disease in infants. Pediatrics 2015; 136 (02) e378-e385
19 Birth Registry Accuracy. OPQC. Available at: https://opqc.net/projects/BirthRegistryAccuracyResources . Accessed March 1, 2018
20 Optimizing Antenatal Use of Steroids to Improve Outcomes for Preterm Infants. Ohio Perinatal Quality Collaborative. Available at: https://opqc.net/sites/bmidrupalpopqc.chmcres.cchmc.org/files/ANCS/Tools/ANCS%20Toolkit_110614.pdf . Accessed August 1, 2017
21 Lannon C, Kaplan HC, Friar K. , et al. Using a state birthregistry as a quality improvement tool. Am J Perinatol 2017; 34 (10) 958-965
22 Kaplan HC, King E, White BE. , et al. Statewide quality improvement initiative to reduce early elective deliveries and improve birth registry accuracy. Obstet Gynecol 2018; 131 (04) 688-695
23 Dietz PM, Bombard JM, Hutchings YL. , et al. Validation of obstetric estimate of gestational age on US birth certificates. Am J Obstet Gynecol 2014; 210 (04) 335.e1-335.e5
24 Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1.American College of Obstetricians and Gynecologists. Obstet Gynecol 2014; 123: 693-711