Abstract：
BACKGROUND: The prevalence of congenital heart disease (CHD) among women of reproductive age is rising. We aimed to investigate the risk of preeclampsia and adverse neonatal outcomes in pregnancies of mothers with CHD compared to pregnancies of mothers without heart disease.
METHODS: In a nationwide cohort of pregnancies in Norway 1994-2014, we retrieved information on maternal heart disease, the course of pregnancy, and neonatal outcomes from national registries. Comparing pregnancies with maternal CHD to pregnancies without maternal heart disease, we used Cox regression to estimate the adjusted hazard ratio (aHR) for preeclampsia and log-binomial regression to estimate the adjusted risk ratio (aRR) for adverse neonatal outcomes. The estimates were adjusted for maternal age and year of childbirth and presented with 95% confidence intervals (CIs).
RESULTS: Among 1 218 452 pregnancies, 2425 had mild maternal CHD, and 603 had moderate/severe CHD. Compared to pregnancies without maternal heart disease, the risk of preeclampsia was increased in pregnancies with mild and moderate/severe maternal CHD (aHR1.37, 95% CI 1.14-1.65 and aHR 1.62, 95% CI 1.13-2.32). The risk of preterm birth was increased in pregnancies with mild maternal CHD (aRR 1.33, 95% CI 1.15-1.54) and further increased with moderate/severe CHD (aRR 2.49, 95% CI 2.03-3.07). Maternal CHD was associated with elevated risks of both spontaneous and iatrogenic preterm birth. The risk of infants small-for-gestational-age was slightly increased with mild maternal CHD (aRR 1.12, 95% CI 1.00-1.26) and increased with moderate/severe CHD (aRR 1.63, 95% CI 1.36-1.95). The prevalence of stillbirth was 3.9 per 1000 pregnancies without maternal heart disease, 5.6 per 1000 with mild maternal CHD, and 6.8 per 1000 with moderate/severe maternal CHD. Still, there were too few cases to report a significant difference. There were no maternal deaths in women with CHD.
CONCLUSIONS: Moderate/severe maternal CHD in pregnancy was associated with increased risks of preeclampsia, preterm birth, and infants small-for-gestational-age. Mild maternal CHD was associated with less increased risks. For women with moderate/severe CHD, their risk of preeclampsia and adverse neonatal outcomes should be evaluated together with their cardiac risk in pregnancy, and follow-up in pregnancy should be ascertained.
METHODS: In a nationwide cohort of pregnancies in Norway 1994-2014, we retrieved information on maternal heart disease, the course of pregnancy, and neonatal outcomes from national registries. Comparing pregnancies with maternal CHD to pregnancies without maternal heart disease, we used Cox regression to estimate the adjusted hazard ratio (aHR) for preeclampsia and log-binomial regression to estimate the adjusted risk ratio (aRR) for adverse neonatal outcomes. The estimates were adjusted for maternal age and year of childbirth and presented with 95% confidence intervals (CIs).
RESULTS: Among 1 218 452 pregnancies, 2425 had mild maternal CHD, and 603 had moderate/severe CHD. Compared to pregnancies without maternal heart disease, the risk of preeclampsia was increased in pregnancies with mild and moderate/severe maternal CHD (aHR1.37, 95% CI 1.14-1.65 and aHR 1.62, 95% CI 1.13-2.32). The risk of preterm birth was increased in pregnancies with mild maternal CHD (aRR 1.33, 95% CI 1.15-1.54) and further increased with moderate/severe CHD (aRR 2.49, 95% CI 2.03-3.07). Maternal CHD was associated with elevated risks of both spontaneous and iatrogenic preterm birth. The risk of infants small-for-gestational-age was slightly increased with mild maternal CHD (aRR 1.12, 95% CI 1.00-1.26) and increased with moderate/severe CHD (aRR 1.63, 95% CI 1.36-1.95). The prevalence of stillbirth was 3.9 per 1000 pregnancies without maternal heart disease, 5.6 per 1000 with mild maternal CHD, and 6.8 per 1000 with moderate/severe maternal CHD. Still, there were too few cases to report a significant difference. There were no maternal deaths in women with CHD.
CONCLUSIONS: Moderate/severe maternal CHD in pregnancy was associated with increased risks of preeclampsia, preterm birth, and infants small-for-gestational-age. Mild maternal CHD was associated with less increased risks. For women with moderate/severe CHD, their risk of preeclampsia and adverse neonatal outcomes should be evaluated together with their cardiac risk in pregnancy, and follow-up in pregnancy should be ascertained.
摘要：
背景：育龄妇女中先天性心脏病（CHD）的患病率正在上升。我们的目的是调查先兆子痫的风险和新生儿不良结局在妊娠的母亲有CHD相比，怀孕的母亲没有心脏病。
方法：在挪威1994-2014年的全国妊娠队列中，我们检索了有关孕产妇心脏病的信息，怀孕的过程，和来自国家登记处的新生儿结局。将妊娠合并CHD的孕妇与没有母亲心脏病的孕妇进行比较，我们使用Cox回归估算子痫前期的校正风险比(aHR),使用对数二项回归估算新生儿不良结局的校正风险比(aRR).根据产妇年龄和分娩年份对估计值进行了调整，并给出了95％的置信区间（CI）。
结果：在1218452例怀孕中，2425患有轻度孕产妇冠心病，和603有中度/重度CHD。与没有母亲心脏病的怀孕相比，孕妇合并轻度和中度/重度CHD的先兆子痫风险增加(aHR1.37,95%CI1.14~1.65和aHR1.62,95%CI1.13~2.32).轻度孕产妇CHD孕妇的早产风险增加（RR1.33，95％CI1.15-1.54），中度/重度CHD孕妇的早产风险进一步增加（RR2.49，95％CI2.03-3.07）。孕产妇CHD与自发性和医源性早产风险升高相关。轻度母体CHD的小于胎龄婴儿的风险略有增加（RR1.12，95％CI1.00-1.26），中度/重度CHD的风险增加（RR1.63，95％CI1.36-1.95）。死产的患病率为每1000例无孕产妇心脏病的孕妇中有3.9例，5.6/1000患有轻度孕产妇CHD，和6.8/1000中度/重度孕产妇CHD。尽管如此，病例太少，无法报告显着差异。CHD女性没有孕产妇死亡。
结论：妊娠中/重度孕产妇冠心病与先兆子痫风险增加相关，早产,和小于胎龄的婴儿。轻度孕产妇CHD与风险增加较少相关。对于患有中度/重度冠心病的女性，他们的先兆子痫和不良新生儿结局的风险应与怀孕时的心脏风险一起评估，应确定怀孕后的随访。
方法：在挪威1994-2014年的全国妊娠队列中，我们检索了有关孕产妇心脏病的信息，怀孕的过程，和来自国家登记处的新生儿结局。将妊娠合并CHD的孕妇与没有母亲心脏病的孕妇进行比较，我们使用Cox回归估算子痫前期的校正风险比(aHR),使用对数二项回归估算新生儿不良结局的校正风险比(aRR).根据产妇年龄和分娩年份对估计值进行了调整，并给出了95％的置信区间（CI）。
结果：在1218452例怀孕中，2425患有轻度孕产妇冠心病，和603有中度/重度CHD。与没有母亲心脏病的怀孕相比，孕妇合并轻度和中度/重度CHD的先兆子痫风险增加(aHR1.37,95%CI1.14~1.65和aHR1.62,95%CI1.13~2.32).轻度孕产妇CHD孕妇的早产风险增加（RR1.33，95％CI1.15-1.54），中度/重度CHD孕妇的早产风险进一步增加（RR2.49，95％CI2.03-3.07）。孕产妇CHD与自发性和医源性早产风险升高相关。轻度母体CHD的小于胎龄婴儿的风险略有增加（RR1.12，95％CI1.00-1.26），中度/重度CHD的风险增加（RR1.63，95％CI1.36-1.95）。死产的患病率为每1000例无孕产妇心脏病的孕妇中有3.9例，5.6/1000患有轻度孕产妇CHD，和6.8/1000中度/重度孕产妇CHD。尽管如此，病例太少，无法报告显着差异。CHD女性没有孕产妇死亡。
结论：妊娠中/重度孕产妇冠心病与先兆子痫风险增加相关，早产,和小于胎龄的婴儿。轻度孕产妇CHD与风险增加较少相关。对于患有中度/重度冠心病的女性，他们的先兆子痫和不良新生儿结局的风险应与怀孕时的心脏风险一起评估，应确定怀孕后的随访。
