부산대학교 도서관

Background: Risk factors for adverse cardiac, obstetric and neonatal outcomes in pregnant women with adult congenital heart disease (ACHD) are not well-defined.Objective: To assess the association of ACHD and serial echo parameters with adverse cardiac, obstetric and neonatal outcomes.Methods: ACHD patients with prenatal care and delivery at a tertiary care center from 2007-2022 were included. Serial echos during pregnancy and adverse cardiac outcomes (arrhythmia, heart failure, ICU admission) were reviewed. Adverse obstetric (pregnancy-induced hypertension, abruption, hemorrhage) and neonatal outcomes (small-for-gestational age, preterm delivery, NICU admission, fetal/neonatal demise) were compared between the ACHD cohort and an age- and gravidity-matched non-ACHD cohort. Logistic regression was used to calculate the odds ratio (OR) for adverse outcomes.Results: Of 188 ACHD patients (mean age 30.9 ± 5.9 years), 74.4% had moderate or greater anatomic complexity. 11.7% of ACHD patients had an adverse cardiac outcome. Adverse obstetric and neonatal outcomes were more common in ACHD patients (23.9% vs 10.4%, p < 0.001; 35.3% vs 17.0%, p < 0.001, respectively). Systemic ventricular dysfunction, systemic atrioventricular valve dysfunction, and decline in systemic ventricular function during pregnancy were associated with increased risk of adverse cardiac outcomes. ACHD was associated with increased risk of adverse obstetric and neonatal outcomes (OR 2.8, 95% Confidence Interval [CI] 1.7 - 4.8; OR 2.8, 95% CI 1.8 - 4.5, respectively). Echo predictors of adverse cardiac outcomes were not associated with increased risk of adverse obstetric or neonatal outcomes.Conclusion: ACHD is associated with adverse cardiac, obstetric and neonatal outcomes. Echo parameters are predictive of adverse cardiac, but not obstetric or neonatal outcomes. Large-scale studies are needed to identify drivers of adverse obstetric and neonatal outcomes in this population.