(879) Assessment of cardiac outcomes in pregnant women with congenital heart disease: a single center experience

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Poojita Dasika, BS (she/her/hers)

Albert Einstein College of Medicine
The Bronx, New York, United States

Coauthor(s)

SR

Shreya Ramineni, BS

Albert Einstein College of Medicine
Bronx, New York, United States
Anna E. Bortnick, MD, PhD (she/her/hers)

Associate Professor
Montefiore Medical Center/Albert Einstein College of Medicine
Bronx, New York, United States
MG

Manoj Gupta, MD

Montefiore Medical Center/Albert Einstein College of Medicine
Bronx, New York, United States
DH

Daphne Hsu, MD

Montefiore Medical Center/Albert Einstein College of Medicine
Bronx, New York, United States
Diana S. Wolfe, MD, MPH

Associate Professor of Obstetrics & Gynecology and Women's Health, Maternal Fetal Medicine Associate Professor of Medicine, Cardiology Maternal Fetal Medicine Cardiology Joint Program
Montefiore Medical Center/Albert Einstein College of Medicine
Bronx, New York, United States

Objective: Women with congenital heart disease (CHD) have a significant risk of cardiovascular complications during pregnancy. This study examined the association between current cardiac risk stratification tools and cardiovascular outcomes in adult pregnant women with CHD.

Study Design: A retrospective observational study was performed via chart review of all patients ≥ 18 years of age with underlying mild, moderate, or complex CHD who received care at the Albert Einstein College of Medicine at the Montefiore Medical Center, Bronx, New York from January 2015 until April 2024. Pregnancy risk scores were calculated using the mWHO, ZAHARA, CARPREG I, and CARPREG II risk classification models. The primary outcome was to compare the observed versus predicted occurrence of maternal cardiovascular complications by each model. Secondary outcomes included identifying individual risk factors for maternal cardiovascular complications. A univariate analysis was performed to identify significant predictors of cardiovascular complications.

Results: Of 170 pregnancies, 16 (9.4%) had cardiovascular complications antepartum or up to 6 months postpartum. The ratio of weighted average observed risk within the cohort to weighted average predicted risk was calculated for each model: 0.63 for mWHO, 0.73 for ZAHARA, 0.73 for CARPREG I, and 0.84 for CARPREG II (Figure 1). Significant (p< 0.05) univariate risk factors for maternal cardiovascular complications included anticoagulation during pregnancy, prior cardiac event or arrhythmia, cardiac medication during pregnancy, moderate to severe pulmonary hypertension, systemic ventricular dysfunction, cardiac medication before pregnancy, NYHA functional class >II, and late pregnancy assessment (Table 1).

Conclusion: All four risk models overpredicted maternal cardiac risk. CARPREG II was the most accurate representation of cardiac risk in our cohort of pregnant women in the Bronx with CHD. Though not included in any of the risk models, anticoagulation during pregnancy was the most significant individual predictor of maternal cardiovascular complications.