Pregnancy outcomes of women with congenital heart disease in South Korea: a nationwide cohort study

초록

Objective To assess pregnancy outcomes of women with congenital heart disease Study Design This nationwide cohort study used data from the National Health Insurance Corporation (NHIC) in South Korea from January 1, 2012, and December 31, 2020. We included all Korean women who had more than one delivery during the study period and had been identified with adult congenital heart disease (ACHD) using diagnostic codes within 1 year before delivery for an outpatient or inpatient. Primary outcomes included maternal composite morbidity (preeclampsia, gestational diabetes, placental abruption, placenta previa, stillbirth, preterm birth, postpartum hemorrhage) and neonatal morbidity (low-birth-weight infants, large-for-gestational-age infants). Results The 2,911 women with ACHD (0.11%) included in the analysis of maternal outcomes had significantly higher odds of maternal morbidity compared with women without ACDH (n=2,663,588). The maternal composite morbidity showed higher odds in women with ACHD (one or more: aOR, 1.324 [95% CI, 1.1.216-1.442]; one: aOR 1.262 [1.154-1.380]; two: aOR 1.593 [1.292-1.965]; three or more: aOR 2.023 [1.086-3.767]). Women with ACHD had significantly higher odds of preterm birth (aOR, 2.218; 95% CI, 1.804-2.726) and low birth weight (LBW) infants (aOR, 1.331; 95% CI, 1.164-1.522). The frequency of stillbirth was not different between women without ACHD (0.02%) and those with ACHD (0%). Conclusion With help of exact prenatal and postnatal diagnosis and advanced surgical and/or medical treatment, women with ACHD who survived could have healthy pregnancies. However, the risk of preterm birth and maternal morbidity is still higher in women with ACHD. Therefore, optimal clinical care should be considered to reduce the heightened risks of ACHD.