Background

In women with congenital heart defects (CHD), changes in blood volume, heart rate, respiration, and edema during pregnancy may lead to increased risk of adverse outcomes and conditions. The American Heart Association (AHA) recommends providers of pregnant women with CHD assess cardiac health and discuss risks and benefits of cardiac-related medications. We described receipt of AHA-recommended cardiac evaluations, filled potentially teratogenic or fetotoxic (Food and Drug Administration pregnancy category D/X) cardiac-related prescriptions, and adverse conditions among pregnant women with CHD compared to those without CHD.

Methods and Results

Using 2007–2014 U.S. healthcare claims data, we ascertained a retrospective cohort of women with and without CHD ages 15–44 years with private insurance covering prescriptions during pregnancy. CHD was defined as ≥1 inpatient code or ≥2 outpatient CHD diagnosis codes >30 days apart documented outside of pregnancy and categorized as severe or non-severe. Log-linear regression, accounting for multiple pregnancies per woman, generated adjusted prevalence ratios (aPR) for associations between presence/severity of CHD and stillbirth, preterm birth, and adverse conditions from last menstrual period (LMP) to 90 days postpartum. We identified 2,056 women with CHD (2,334 pregnancies) and 1,374,982 women without (1,524,077 pregnancies). During LMP to 90 days postpartum, 56% of women with CHD had comprehensive echocardiograms and, during pregnancy, 4% filled potentially teratogenic or fetotoxic cardiac-related prescriptions. Women with CHD, compared to those without, experienced more adverse conditions overall (aPR=1.9, 95% CI:1.7–2.1) and, specifically, obstetric (aPR=1.3, 95% CI:1.2–1.4) and cardiac conditions (aPR=10.2, 95% CI:9.1–11.4); stillbirth (aPR=1.6, 95% CI:1.1–2.4); and preterm delivery (aPR=1.6, 95% CI:1.4–1.8). More women with severe CHD, compared to non-severe, experienced adverse conditions overall (aPR=1.5, 95% CI:1.2–1.9).

Conclusions

Women with CHD have elevated prevalence of adverse cardiac and obstetric conditions during pregnancy, 4 in 100 used potentially teratogenic or fetotoxic medications, and only half received an AHA-recommended comprehensive echocardiogram.