Aims The aim of this study was to provide population-based data on maternal and neonatal complications and outcome in the pregnancies of women with congenital heart disease (CHD). Methods and results Based on administrative data from one of the largest German Health Insurance Companies (BARMER GEK, ∼9 million members representative for Germany), all pregnancies in women with CHD between 2005 and 2018 were analysed. In addition, an age-matched non-CHD control group was included for comparison and the association between adult CHD (ACHD) and maternal or neonatal outcomes investigated. Overall, 7512 pregnancies occurred in 4015 women with CHD. The matched non-CHD control group included 6502 women with 11 225 pregnancies. Caesarean deliveries were more common in CHD patients (40.5% vs. 31.5% in the control group; P < 0.001). There was no excess mortality. Although the maternal complication rate was low in absolute terms, women with CHD had a significantly higher rate of stroke, heart failure and cardiac arrhythmias during pregnancy (P < 0.001 for all). Neonatal mortality was low but also significantly higher in the ACHD group (0.83% vs. 0.22%; P = 0.001) and neonates to CHD mothers had low/extremely low birth weight or extreme immaturity (<0.001) or required resuscitation and mechanical ventilation more often compared to non-CHD offspring (P < 0.001 for both). On multivariate logistic regression maternal defect complexity, arterial hypertension, heart failure, prior fertility treatment, and anticoagulation with vitamin K antagonists emerged as significant predictors of adverse neonatal outcome (P < 0.05 for all). Recurrence of CHD was 6.1 times higher in infants to ACHD mothers compared to controls (P < 0.0001). Conclusions This population-based study illustrates a reassuringly low maternal mortality rate in a highly developed healthcare system. Nevertheless, maternal morbidity and neonatal morbidity/mortality were significantly increased in women with ACHD and their offspring compared to non-ACHD controls highlighting the need of specialized care and pre-pregnancy counselling.

中文翻译：

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先天性心脏病女性的孕产妇和新生儿并发症：一项全国性分析

目的 本研究的目的是提供基于人群的先天性心脏病 (CHD) 妇女妊娠中孕产妇和新生儿并发症和结局的数据。方法和结果 根据德国最大的健康保险公司之一（BARMER GEK，代表德国的约 900 万会员）的管理数据，分析了 2005 年至 2018 年期间患有冠心病的女性的所有妊娠情况。此外，还纳入了一个年龄匹配的非 CHD 对照组进行比较，并研究了成人 CHD (ACHD) 与孕产妇或新生儿结局之间的关联。总体而言，4015 名患有冠心病的女性中有 7512 次怀孕。匹配的非 CHD 对照组包括 6502 名女性，11225 次怀孕。剖宫产在 CHD 患者中更为常见（对照组为 40.5% 对 31.5%；P < 0.001）。没有过多的死亡率。尽管母体并发症发生率绝对值较低，但患有 CHD 的女性在妊娠期间中风、心力衰竭和心律失常的发生率显着较高（所有人的 P < 0.001）。ACHD 组的新生儿死亡率较低，但也显着较高（0.83% 对 0.22%；P = 0.001），CHD 母亲的新生儿出生体重低/极低或极度不成熟（<0.001）或需要复苏和机械通气与非 CHD 后代相比更常见（两者的 P < 0.001）。在多变量逻辑回归中，母体缺陷复杂性、动脉高血压、心力衰竭、先前的生育治疗和维生素 K 拮抗剂抗凝成为新生儿不良结局的重要预测因素（所有 P < 0.05）。CHD 复发 6 次。与对照组相比，ACHD 母亲的婴儿高 1 倍（P < 0.0001）。结论 这项基于人群的研究表明，在高度发达的医疗保健系统中，孕产妇死亡率低得令人放心。然而，与非 ACHD 对照相比，ACHD 女性及其后代的孕产妇发病率和新生儿发病率/死亡率显着增加，这突出了对专业护理和孕前咨询的需求。