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Obstetric outcome in women with congenital heart disease : A nationwide cohort in Sweden

Wedlund, Frida LU ; Widing, Ellen LU ; von Wowern, Emma LU orcid ; Christensson, Christina ; Lindstedt, Sandra LU ; Sörensson, Peder ; Trzebiatowska-Krzynska, Aleksandra ; Mandalenakis, Zacharias ; Bay, Annika and Johansson, Bengt , et al. (2025) In Acta Obstetricia et Gynecologica Scandinavica
Abstract

INTRODUCTION: Survival and healthcare for patients with congenital heart disease have improved, and the number of pregnancies among women of childbearing age with congenital heart disease has increased. Our aim was to investigate obstetric outcomes in a large retrospective, national registry study of women with congenital heart disease compared to controls.

MATERIAL AND METHODS: The study included women over 18 years of age from the Swedish Registry of Congenital Heart Disease. Each case was matched with 10 controls from Statistics Sweden, based on the mother's birth year and birth county and all were subsequently linked to the Swedish Medical Birth Register. We included 7998 pregnancies in women with congenital heart disease and... (More)

INTRODUCTION: Survival and healthcare for patients with congenital heart disease have improved, and the number of pregnancies among women of childbearing age with congenital heart disease has increased. Our aim was to investigate obstetric outcomes in a large retrospective, national registry study of women with congenital heart disease compared to controls.

MATERIAL AND METHODS: The study included women over 18 years of age from the Swedish Registry of Congenital Heart Disease. Each case was matched with 10 controls from Statistics Sweden, based on the mother's birth year and birth county and all were subsequently linked to the Swedish Medical Birth Register. We included 7998 pregnancies in women with congenital heart disease and 84 799 in controls during 1973-2020.

RESULTS: The mean age at delivery for women with congenital heart disease and controls was 28.7 (±5.0) and 28.7 (±5.1) years, respectively. Women with congenital heart disease smoked less, had a shorter gestation and a higher incidence of delivery by Cesarean section compared to controls. The likelihood of Cesarean section was increased in women with congenital heart disease compared to controls: odds ratio 1.45 (95% confidence interval (CI) 1.37-1.54). Compared to controls, women with congenital heart disease had an increased likelihood of giving birth to small-for-gestational-age neonates: odds ratio 1.40 (95% CI 1.23-1.58). The association regarding small-for-gestational-age remained after adjusting for body mass index, age, smoking, comorbid diseases and preeclampsia. Women with congenital heart disease had an increased likelihood of prematurity compared to controls: odds ratio 1.47 (95% CI 1.35-1.59). The likelihood of Cesarean section, small-for-gestational-age neonates and prematurity was higher in women with severe congenital heart disease than mild/moderate congenital heart disease, both compared to controls.

CONCLUSIONS: In this large national case-control study in women with congenital heart disease, we showed an increased likelihood of giving birth prematurely by Cesarean section, and having a small-for-gestational-age neonate compared to matched controls. The likelihood seems even higher in women with severe congenital heart disease. Further research is needed to explore the underlying reasons for the high rates of Cesarean section in women with congenital heart disease.

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publication status
epub
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Acta Obstetricia et Gynecologica Scandinavica
article number
700093
publisher
Wiley-Blackwell
external identifiers
  • pmid:41239781
  • scopus:105021831814
ISSN
1600-0412
DOI
10.1111/aogs.70093
language
English
LU publication?
yes
additional info
© 2025 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).
id
6de7209d-5398-433a-a8a4-16ae276fa627
date added to LUP
2025-12-03 14:54:25
date last changed
2025-12-04 08:52:16
@article{6de7209d-5398-433a-a8a4-16ae276fa627,
  abstract     = {{<p>INTRODUCTION: Survival and healthcare for patients with congenital heart disease have improved, and the number of pregnancies among women of childbearing age with congenital heart disease has increased. Our aim was to investigate obstetric outcomes in a large retrospective, national registry study of women with congenital heart disease compared to controls.</p><p>MATERIAL AND METHODS: The study included women over 18 years of age from the Swedish Registry of Congenital Heart Disease. Each case was matched with 10 controls from Statistics Sweden, based on the mother's birth year and birth county and all were subsequently linked to the Swedish Medical Birth Register. We included 7998 pregnancies in women with congenital heart disease and 84 799 in controls during 1973-2020.</p><p>RESULTS: The mean age at delivery for women with congenital heart disease and controls was 28.7 (±5.0) and 28.7 (±5.1) years, respectively. Women with congenital heart disease smoked less, had a shorter gestation and a higher incidence of delivery by Cesarean section compared to controls. The likelihood of Cesarean section was increased in women with congenital heart disease compared to controls: odds ratio 1.45 (95% confidence interval (CI) 1.37-1.54). Compared to controls, women with congenital heart disease had an increased likelihood of giving birth to small-for-gestational-age neonates: odds ratio 1.40 (95% CI 1.23-1.58). The association regarding small-for-gestational-age remained after adjusting for body mass index, age, smoking, comorbid diseases and preeclampsia. Women with congenital heart disease had an increased likelihood of prematurity compared to controls: odds ratio 1.47 (95% CI 1.35-1.59). The likelihood of Cesarean section, small-for-gestational-age neonates and prematurity was higher in women with severe congenital heart disease than mild/moderate congenital heart disease, both compared to controls.</p><p>CONCLUSIONS: In this large national case-control study in women with congenital heart disease, we showed an increased likelihood of giving birth prematurely by Cesarean section, and having a small-for-gestational-age neonate compared to matched controls. The likelihood seems even higher in women with severe congenital heart disease. Further research is needed to explore the underlying reasons for the high rates of Cesarean section in women with congenital heart disease.</p>}},
  author       = {{Wedlund, Frida and Widing, Ellen and von Wowern, Emma and Christensson, Christina and Lindstedt, Sandra and Sörensson, Peder and Trzebiatowska-Krzynska, Aleksandra and Mandalenakis, Zacharias and Bay, Annika and Johansson, Bengt and Hlebowicz, Joanna}},
  issn         = {{1600-0412}},
  language     = {{eng}},
  month        = {{11}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Obstetricia et Gynecologica Scandinavica}},
  title        = {{Obstetric outcome in women with congenital heart disease : A nationwide cohort in Sweden}},
  url          = {{http://dx.doi.org/10.1111/aogs.70093}},
  doi          = {{10.1111/aogs.70093}},
  year         = {{2025}},
}