(493) Maternal Cardiac and Perinatal Outcomes Among Pregnant Individuals with Ebstein’s Anomaly

Objective: Ebstein’s anomaly, a congenital cardiac condition, is defined by apical displacement of the tricuspid valve and atrialization of the inlet portion of the right ventricle. Advancement in cardiac intervention over time has led to an increase in people with Ebstein’s anomaly surviving into the reproductive years. Due to its historical early lethality, the impacts of this condition are not well known in pregnancy. The objective of this study was to describe the maternal cardiac and perinatal outcomes associated with maternal Ebstein’s anomaly in pregnancy through use of a large, contemporary dataset.

Study Design: Utilizing Epic Cosmos, an integrated dataset from over 1500 hospitals across the United States and includes 250 million patients, we identified a cohort of pregnancies among individuals with maternal Ebstein’s anomaly. Individuals with simultaneous diagnoses codes for maternal Ebstein’s anomaly and pregnancy between July 2021 and July 2024 were identified. Descriptive statistics, including demographics, cardiac and perinatal outcomes were obtained.

Results: During the study period, 487 individuals with a maternal Ebstein’s anomaly and pregnancy were identified. Subjects were a mean age of 32.0 years old (±9 years) and identified as predominately White (78.9%). Approximately 30.8% of patients experienced a cardiac arrhythmia, while 14.8% developed heart failure. The most common arrhythmias were supraventricular tachycardias (SVT) (52%) and atrial fibrillation/flutter (36%). There was complete obstetric outcome data available for 235 individuals (48.2%). The average gestational age at delivery was 35.4 weeks (± 9.1 weeks) with 13.2% experiencing a preterm birth less than 37 weeks. Regarding mode of delivery, 77.0% had a vaginal delivery, while 23.0% had a cesarean delivery.

Conclusion: Ebstein’s anomaly is associated with significant cardiac risks in pregnancy, specifically cardiac arrhythmia. Further prospective studies are needed in modern cohorts to guide optimal management of pregnant patients with Ebstein’s anomaly and to determine the highest risk time period for cardiac complications.