P6189Pregnancy in adults with congenital heart disease in England between 1997 and 2015: Clinical outcomes and risk factors for the peri-partum period

Abstract

Background/Introduction: In an expanding population of women with congenital heart disease (CHD) of child-bearing age, the post-partum represents a period of increased risk for mother and child. The 2011 European Society of Cardiology guidelines on the management of cardiovascular diseases during pregnancy emphasise the importance of high quality pre-pregnancy counselling, which requires accurate estimation of risks associated with pregnancy and delivery. While risk stratification tools are available for pregnancy, little is known about the risk in postpartum period. Contemporary, population-level data of delivery complications are needed to inform future guidelines and pre-pregnancy counselling. Purpose: We aimed to assess the peri-partum morbidity and mortality in CHD patients in England over the last 17 years. Methods: Retrospective analysis of the hospital episode statistics database for England from 1997 to 2015 was performed. Data recorded for hospitalised patients include diagnoses coded using the International Classification of Diseases system (ICD-10) and treatment using the Office for Population Censuses and Surveys (OPCS-4) Classification of Interventions and Procedures. We identified all female patients with CHD. Whenever possible, patients were classified into “simple”, “moderate” or “complex” CHD in line with the 32nd Bethesda conference document. A combined end-point of mortality or re-admission within the postpartum period with heart failure or arrhythmia, or delivery admission >7 days was used. The association between the combined end-point, disease complexity and age was assessed using multivariate logistic regression (p<0.05 indicative of statistical significance). Results: During the study period, 29,071 delivery episodes occurred in 16,865 CHD patients [median age 28, range 13-52 years]. CHD complexity could be classified in 20,158 of these: 12,126 (60.1%) had simple, 6355 (31.5%) moderate and 1677 (8.3%) greatly complex defects. The delivery episode lasted a median 1 day [range 0-217 days]; 6.5% of episodes lasted more than 7 days. Overall mortality during the post-partum period was low, affecting 11 women (0.07%). Maternal deaths were attributed to pulmonary embolism (2), sepsis (2), heart failure (1), as a result of anaesthesia (1), and complication of Caesarean-section wound (1). Disease complexity was a strong predictor of the combined end-point being met (odds ratio versus [a] simple CHD of 5.28, CI 3.19-8.60, p<0.001; [b] moderate CHD of 3.20, CI 1.8-5.34, p<0.01). In women with simple CHD over the age of 37, there was a significant association of age and the combined end-point (p<0.01) (Figure 1). Conclusions: Pregnancy is safe for the majority of women with CHD. However, in a minority of patients, especially those with greater disease complexity, but also older women with simple lesions, peri-partum morbidity is increased.Women with ACHD should be assessed and cared for in expert centres to minimise risks. (Figure Presented).