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The modified WHO class is associated with maternal complications in women with congenital heart disease

Jonsson, Sara ; Johansson, Bengt ; Wikström, Anna Karin ; Dahlqvist, Jenny Alenius ; Christersson, Christina ; Sörensson, Peder ; Trzebiatowska-Krzynska, Aleksandra ; Dellborg, Mikael ; Thilén, Ulf LU and Sundström-Poromaa, Inger , et al. (2025) In European Heart Journal Open 5(4).
Abstract

Aims With a growing population of women with congenital heart disease (CHD), pregnancies in this group are expected to increase. However, pregnancy in women with CHD is associated with increased adverse outcomes for both mother and child. The aim of this study was to evaluate pregnancy and foetal complications in women with CHD and to test their association with the modified WHO (mWHO) classification. Methods Using two national registers, the national register for CHD and the Pregnancy Register, primiparous women giving birth and results between 2014 and 2019 were identified. Women with CHD, n = 829, and women without CHD, n = 4137, were matched by birth year and municipality in a ∼1:5 ratio. The women with CHD were classified according... (More)

Aims With a growing population of women with congenital heart disease (CHD), pregnancies in this group are expected to increase. However, pregnancy in women with CHD is associated with increased adverse outcomes for both mother and child. The aim of this study was to evaluate pregnancy and foetal complications in women with CHD and to test their association with the modified WHO (mWHO) classification. Methods Using two national registers, the national register for CHD and the Pregnancy Register, primiparous women giving birth and results between 2014 and 2019 were identified. Women with CHD, n = 829, and women without CHD, n = 4137, were matched by birth year and municipality in a ∼1:5 ratio. The women with CHD were classified according to the mWHO criteria. Caesarean deliveries (25.7 vs. 17.2%, P < 0.001), preterm delivery (10.3 vs. 6.4%, P < 0.001), and preeclampsia (6.2 vs. 4.1%, P = 0.007) were more common in women with CHD compared with controls. Using logistic regression, there was an association between high mWHO class (mWHO III, IV) and caesarean section [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.8–6.7], preterm birth (<37 weeks) (OR 8.3, 95% CI 4.1–17.1), and preeclampsia (OR 3.8, 95% CI 1.5–9.9). Conclusion Pregnancy complications are more common in women with CHD. In women with CHD, the mWHO classification is associated with maternal complications and preterm birth. Thus, large national register data corroborate the advice provided in current guidelines, and the mWHO class is deemed a valuable risk stratification tool in women with CHD.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adult congenital heart disease, mWHO, Pregnancy
in
European Heart Journal Open
volume
5
issue
4
article number
oeaf081
publisher
Oxford University Press
external identifiers
  • scopus:105010587443
ISSN
2752-4191
DOI
10.1093/ehjopen/oeaf081
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2025.
id
fbcc4534-758e-469d-b9f3-3b2ccc1bbc26
date added to LUP
2025-12-15 16:13:11
date last changed
2025-12-15 16:14:28
@article{fbcc4534-758e-469d-b9f3-3b2ccc1bbc26,
  abstract     = {{<p>Aims With a growing population of women with congenital heart disease (CHD), pregnancies in this group are expected to increase. However, pregnancy in women with CHD is associated with increased adverse outcomes for both mother and child. The aim of this study was to evaluate pregnancy and foetal complications in women with CHD and to test their association with the modified WHO (mWHO) classification. Methods Using two national registers, the national register for CHD and the Pregnancy Register, primiparous women giving birth and results between 2014 and 2019 were identified. Women with CHD, n = 829, and women without CHD, n = 4137, were matched by birth year and municipality in a ∼1:5 ratio. The women with CHD were classified according to the mWHO criteria. Caesarean deliveries (25.7 vs. 17.2%, P &lt; 0.001), preterm delivery (10.3 vs. 6.4%, P &lt; 0.001), and preeclampsia (6.2 vs. 4.1%, P = 0.007) were more common in women with CHD compared with controls. Using logistic regression, there was an association between high mWHO class (mWHO III, IV) and caesarean section [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.8–6.7], preterm birth (&lt;37 weeks) (OR 8.3, 95% CI 4.1–17.1), and preeclampsia (OR 3.8, 95% CI 1.5–9.9). Conclusion Pregnancy complications are more common in women with CHD. In women with CHD, the mWHO classification is associated with maternal complications and preterm birth. Thus, large national register data corroborate the advice provided in current guidelines, and the mWHO class is deemed a valuable risk stratification tool in women with CHD.</p>}},
  author       = {{Jonsson, Sara and Johansson, Bengt and Wikström, Anna Karin and Dahlqvist, Jenny Alenius and Christersson, Christina and Sörensson, Peder and Trzebiatowska-Krzynska, Aleksandra and Dellborg, Mikael and Thilén, Ulf and Sundström-Poromaa, Inger and Bay, Annika}},
  issn         = {{2752-4191}},
  keywords     = {{Adult congenital heart disease; mWHO; Pregnancy}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{4}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal Open}},
  title        = {{The modified WHO class is associated with maternal complications in women with congenital heart disease}},
  url          = {{http://dx.doi.org/10.1093/ehjopen/oeaf081}},
  doi          = {{10.1093/ehjopen/oeaf081}},
  volume       = {{5}},
  year         = {{2025}},
}