Outcomes of Pregnant Women Hospitalized with Unrepaired Congenital Heart Disease: Insights from a Multidisciplinary Center in Vietnam

Overview

Journal Obstet Med

Specialty Gynecology & Obstetrics

Date 2023 Dec 11

PMID 38074201

Authors

Thanh-Huong Truong

Ngoc-Thanh Kim

Dinh-Phuc Nguyen

Mai-Ngoc Thi Nguyen

Doan-Loi Do

Thanh-Tung Le

Hong-An Le

Affiliations

Soon will be listed here.

Abstract

Background: In developing countries, fewer women have access to multidisciplinary congenital heart disease and reproductive programs staffed by experts. We report pregnancy outcomes of a multidisciplinary healthcare strategy utilizing an in-hospital teamwork approach in Vietnam.

Methods: This retrospective cohort study included pregnant women with unrepaired congenital heart disease managed at a referral cardiovascular center.

Results: Undiagnosed congenital heart disease before pregnancy, a lack of pre-pregnancy cardiology counseling, and modified World Health Organization class III/IV were common. Under the multispecialty healthcare strategy, although the rate of maternal death was 8.2% in the modified World Health Organization class IV group, no deaths occurred in any other group. Fetal/neonatal complications occurred in 54% of pregnancies, and 49.4% of neonates survived. Poor pregnancy outcomes were associated with admission during the first/seconde trimester for fetus/neonates, third trimester for mother, modified World Health Organization class III/IV, cyanosis, and heart failure.

Conclusion: The outcomes of pregnant women with unrepaired congenital heart disease were poor but seemed to improve with a multidisciplinary in-hospital healthcare teamwork strategy.

Citing Articles

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Chen J, Yao Q, Wang X, Jiang J, Zhu H, Yu D J Multidiscip Healthc. 2025; 17:6187-6198.

PMID: 39759085 PMC: 11697645. DOI: 10.2147/JMDH.S504720.

References

Suwanrath C, Thongphanang P, Pinjaroen S, Suwanugsorn S . Validation of modified World Health Organization classification for pregnant women with heart disease in a tertiary care center in southern Thailand. Int J Womens Health. 2018; 10:47-53. PMC: 5779307. DOI: 10.2147/IJWH.S150767. View

Thornburg K, Jacobson S, Giraud G, Morton M . Hemodynamic changes in pregnancy. Semin Perinatol. 2000; 24(1):11-4. DOI: 10.1016/s0146-0005(00)80047-6. View

Drenthen W, Pieper P, Roos-Hesselink J, van Lottum W, Voors A, Mulder B . Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol. 2007; 49(24):2303-11. DOI: 10.1016/j.jacc.2007.03.027. View

Stout K, Daniels C, Aboulhosn J, Bozkurt B, Broberg C, Colman J . 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018; 139(14):e698-e800. DOI: 10.1161/CIR.0000000000000603. View

Chu R, Chen W, Song G, Yao S, Xie L, Song L . Predicting the Risk of Adverse Events in Pregnant Women With Congenital Heart Disease. J Am Heart Assoc. 2020; 9(14):e016371. PMC: 7660735. DOI: 10.1161/JAHA.120.016371. View

Hrycyk J, Kaemmerer H, Nagdyman N, Hamann M, Schneider K, Kuschel B . Mode of Delivery and Pregnancy Outcome in Women with Congenital Heart Disease. PLoS One. 2016; 11(12):e0167820. PMC: 5179127. DOI: 10.1371/journal.pone.0167820. View

Taylor C, McCance D, Chappell L, Nelson-Piercy C, Thorne S, Ismail K . Implementation of guidelines for multidisciplinary team management of pregnancy in women with pre-existing diabetes or cardiac conditions: results from a UK national survey. BMC Pregnancy Childbirth. 2017; 17(1):434. PMC: 5741950. DOI: 10.1186/s12884-017-1609-9. View

Liu Y, Chen S, Zuhlke L, Babu-Narayan S, Black G, Choy M . Global prevalence of congenital heart disease in school-age children: a meta-analysis and systematic review. BMC Cardiovasc Disord. 2020; 20(1):488. PMC: 7678306. DOI: 10.1186/s12872-020-01781-x. View

van der Bom T, Bouma B, Meijboom F, Zwinderman A, Mulder B . The prevalence of adult congenital heart disease, results from a systematic review and evidence based calculation. Am Heart J. 2012; 164(4):568-75. DOI: 10.1016/j.ahj.2012.07.023. View

10.

Nguyen Manh T, Bui Van N, Le Thi H, Vo Hoang L, Nguyen Si Anh H, Thi Thu H . Pregnancy with Heart Disease: Maternal Outcomes and Risk Factors for Fetal Growth Restriction. Int J Environ Res Public Health. 2019; 16(12). PMC: 6616620. DOI: 10.3390/ijerph16122075. View

11.

Wu M, Lu C, Chen H, Kao F, Huang S . Adult Congenital Heart Disease in a Nationwide Population 2000-2014: Epidemiological Trends, Arrhythmia, and Standardized Mortality Ratio. J Am Heart Assoc. 2018; 7(4). PMC: 5850200. DOI: 10.1161/JAHA.117.007907. View

12.

Roos-Hesselink J, Baris L, Johnson M, De Backer J, Otto C, Marelli A . Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC). Eur Heart J. 2019; 40(47):3848-3855. DOI: 10.1093/eurheartj/ehz136. View

13.

Easter S, Valente A, Economy K . Creating a Multidisciplinary Pregnancy Heart Team. Curr Treat Options Cardiovasc Med. 2020; 22(1):3. DOI: 10.1007/s11936-020-0800-x. View

14.

Ladouceur M, Benoit L, Radojevic J, Basquin A, Dauphin C, Hascoet S . Pregnancy outcomes in patients with pulmonary arterial hypertension associated with congenital heart disease. Heart. 2016; 103(4):287-292. DOI: 10.1136/heartjnl-2016-310003. View

15.

Ishida S, Uchiyama A, Imai K, Kusuda S . Brain-type natriuretic peptide level in pregnant women with congenital heart disease predicts SGA offspring. Pediatr Int. 2019; 61(12):1221-1226. DOI: 10.1111/ped.13997. View

16.

Dimopoulos K, Diller G, Giannakoulas G, Petraco R, Chamaidi A, Karaoli E . Anemia in adults with congenital heart disease relates to adverse outcome. J Am Coll Cardiol. 2009; 54(22):2093-100. DOI: 10.1016/j.jacc.2009.06.050. View

17.

Zuhlke L, Lawrenson J, Comitis G, De Decker R, Brooks A, Fourie B . Congenital Heart Disease in Low- and Lower-Middle-Income Countries: Current Status and New Opportunities. Curr Cardiol Rep. 2019; 21(12):163. DOI: 10.1007/s11886-019-1248-z. View

18.

Ramage K, Grabowska K, Silversides C, Quan H, Metcalfe A . Association of Adult Congenital Heart Disease With Pregnancy, Maternal, and Neonatal Outcomes. JAMA Netw Open. 2019; 2(5):e193667. PMC: 6512464. DOI: 10.1001/jamanetworkopen.2019.3667. View

19.

Drenthen W, Boersma E, Balci A, Moons P, Roos-Hesselink J, Mulder B . Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J. 2010; 31(17):2124-32. DOI: 10.1093/eurheartj/ehq200. View

20.

Galie N, Humbert M, Vachiery J, Gibbs S, Lang I, Torbicki A . 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS):.... Eur Heart J. 2015; 37(1):67-119. DOI: 10.1093/eurheartj/ehv317. View