Dutch acronym: Zwangerschap bij Aangeboren HARtAfwijkingen [Pregnancy in Congenital Heart Disease].
Comparison of pregnancy outcomes in women with repaired versus unrepaired atrial septal defect
Article first published online: 14 AUG 2009
© 2009 The Authors Journal compilation © RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 116, Issue 12, pages 1593–1601, November 2009
How to Cite
Yap, S.-C., Drenthen, W., Meijboom, F., Moons, P., Mulder, B., Vliegen, H., van Dijk, A., Jaddoe, V., Steegers, E., Roos-Hesselink, J., Pieper, P. and on behalf of the ZAHARA investigators (2009), Comparison of pregnancy outcomes in women with repaired versus unrepaired atrial septal defect. BJOG: An International Journal of Obstetrics & Gynaecology, 116: 1593–1601. doi: 10.1111/j.1471-0528.2009.02301.x
- Issue published online: 9 OCT 2009
- Article first published online: 14 AUG 2009
- Accepted 2 June 2009. Published Online 14 August 2009.
- atrial septal defect;
- congenital heart disease;
Objective To compare the risks of complications during pregnancy in women with repaired and unrepaired atrial septal defects (ASDs) without associated complex cardiac lesions.
Design A retrospective multicentre study.
Setting Tertiary centres in the Netherlands and Belgium.
Population Women with ASD without associated complex cardiac lesions.
Methods Women were identified using two congenital heart disease registries. One hundred women were identified who had 243 pregnancies, including 49 miscarriages and six terminations of pregnancy. Detailed information on each completed pregnancy (n = 188; unrepaired ASD, n = 133; repaired ASD, n = 55) was obtained using medical records and telephone interviews. In addition, data from the Generation R database (a prospective cohort study; n = 9667) were used to determine the background risk (control group).
Main outcome measures Adjusted odds ratios (AORs) for cardiac, obstetric and neonatal events controlled for multiple pregnancies per woman using general estimating equation analysis.
Results Women with an unrepaired ASD had a higher risk of neonatal events (AOR = 2.99, 95% confidence interval [CI] 1.14–7.89, P = 0.027) than women with a repaired ASD. The risk of cardiac and obstetric complications was comparable between women with unrepaired and repaired ASDs. Compared with the general population, women with an unrepaired ASD had higher risks of pre-eclampsia (AOR = 3.54, 95% CI 1.26–9.98, P = 0.017), small-for-gestational-age births (AOR = 1.95, 95% CI 1.15–3.30, P = 0.013) and fetal mortality (AOR = 5.55, 95% CI 1.77–17.4, P = 0.003). By contrast, no differences were observed when comparing women with a repaired ASD versus controls.
Conclusions Women with an unrepaired ASD are at increased risk of neonatal events in comparison with women with a repaired ASD. Compared with the general population, women with an unrepaired ASD are at increased risk of pre-eclampsia, small-for-gestational-age births and fetal mortality.