Labor onset and delivery mode in women with congenital heart disease—A nationwide cohort study

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2025-01-29 DOI:10.1111/aogs.15064

Marit Sandberg, Tatiana Fomina, Ferenc Macsali, Gottfried Greve, Nina Øyen, Elisabeth Leirgul

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Abstract

Introduction

More women with congenital heart disease (CHD) are pursuing pregnancy. Their cardiac condition may impact the pregnancy and necessitate interventions during childbirth. We aimed to investigate labor onset and delivery mode in women with CHD relative to women without heart disease and explore the time trends of induced labor and cesarean deliveries.

Material and Methods

In a nationwide cohort in Norway from 1994 to 2014, we compared childbirths of women with mild, moderate/severe, or other CHD to childbirths of women without heart disease. Associations between maternal CHD and labor onset and delivery mode were estimated using log-binomial regression. Time trends were assessed using Joinpoint regression.

Results

Among 1 218 452 childbirths, 2425 (20 per 10 000) had mild maternal CHD, 603 (5 per 10 000) moderate/severe maternal CHD, and 522 (4 per 10 000) other maternal CHD. Mild maternal CHD was associated with induced labor (aRR 1.11, 95% CI 1.01–1.22) and cesarean delivery (aRR 1.27, 95% CI 1.18–1.39), and the associations were stronger with moderate/severe CHD (induced labor: aRR 1.34, 95% CI 1.13–1.58; cesarean delivery: aRR 1.80, 95% CI 1.57–2.05) and other CHD (induced labor: aRR 1.39, 95% CI 1.17–1.66; cesarean delivery: aRR 1.62, 95% CI 1.39–1.89). From the first seven years (1994–2000) to the last (2008–2014), the cesarean delivery occurrence rose about 2% per year in childbirths without maternal heart disease and with mild maternal CHD (from 12.4% to 16.4% and from 14.2% to 21.2%, respectively), but remained stable in childbirths with moderate/severe maternal CHD (23.3% to 25.6%). For induced labor, there was a 2% increase per year in childbirths without maternal heart disease, contrasting a 3%–4% increase in those with mild and moderate/severe maternal CHD.

Conclusions

Maternal CHD was associated with higher risks of induced labor and cesarean delivery. From 1994 to 2014, the increase in induced labor was steeper in childbirths of women with CHD than in those of women without heart disease. The occurrence of cesarean deliveries rose in childbirths of women with mild CHD but was stable in childbirths of women with moderate/severe CHD.

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先天性心脏病妇女的分娩开始和分娩方式：一项全国性队列研究。

越来越多的患有先天性心脏病（CHD）的女性寻求怀孕。她们的心脏状况可能会影响怀孕，在分娩时需要干预。我们的目的是研究冠心病女性与无心脏病女性的分娩时间和分娩方式，并探讨引产和剖宫产的时间趋势。材料和方法：在挪威1994年至2014年的全国队列中，我们比较了患有轻度、中度/重度或其他冠心病的妇女与无心脏病妇女的分娩情况。使用对数二项回归估计产妇冠心病与分娩开始和分娩方式之间的关系。使用Joinpoint回归评估时间趋势。结果：在1218452例分娩中，2425例（20 / 10000）产妇患有轻度冠心病，603例（5 / 10000）产妇患有中/重度冠心病，522例（4 / 10000）产妇患有其他类型的冠心病。母亲轻度冠心病与引产（aRR 1.11, 95% CI 1.01-1.22）和剖宫产（aRR 1.27, 95% CI 1.18-1.39）相关，与中度/重度冠心病(引产：aRR 1.34, 95% CI 1.13-1.58；剖宫产：aRR 1.80, 95% CI 1.57-2.05)和其他冠心病(引产：aRR 1.39, 95% CI 1.17-1.66；剖宫产：aRR 1.62, 95% CI 1.39-1.89)。从前7年（1994-2000年）到后7年（2008-2014年），无心脏病产妇和轻度冠心病产妇的剖宫产率每年上升约2%（分别从12.4%上升到16.4%和14.2%上升到21.2%），但中/重度冠心病产妇的剖宫产率保持稳定（23.3%上升到25.6%）。对于引产而言，无母亲心脏病的分娩每年增加2%，而患有轻度和中度/重度母亲冠心病的分娩每年增加3%-4%。结论：产妇冠心病与引产和剖宫产的高风险相关。从1994年到2014年，冠心病妇女的引产率比无心脏病妇女的引产率增加得更快。在轻度冠心病妇女中，剖宫产的发生率上升，而在中度/重度冠心病妇女中，剖宫产的发生率稳定。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Obstetricia et Gynecologica Scandinavica 医学-妇产科学

CiteScore

8.00

自引率

4.70%

发文量

180

审稿时长

3-6 weeks

期刊介绍： Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.