Effect of Parity on Cardiac Status among Women with Congenital Heart Disease: a Matched Case-Controlled study

Objective: Women with congenital heart disease (CHD) are at risk for cardiac deterioration. Previous studies focused on women after one or two pregnancies. We investigated the effect of parity on maternal cardiac status by comparing women with CHD and ≥3 live births to women with <3 live births. Design. Matched case-controlled study. Setting. Tertiary medical center, clinic for adults with CHD. Population. Twenty-nine women with ≥3 live births, matched (CHD, age) with women with <3 live births. Methods. Women with CHD were identified from the Adult CHD clinic (2010-2018), and data retrieved from medical records. Outcomes were compared for women with ≥3 live births versus <3 live births using the McNemar test. Main outcome measures. New York Heart Association (NYHA) functional classification, and cardiac impairment score assigned according to echocardiography by a cardiologist blinded to parity. Results. For 29 matched pairs with mean age 42.4 (SD 14.2) and 186 live births, the mean difference in number of live births between matched pairs was 3.8 (SD 2.5). In 17 (58.6%) pairs, women with ≥3 live births and those with <3 live births had concordant NYHA class. Echocardiography score was concordant for 19 (65.5%) pairs. Women with ≥3 live births had lower NYHA class in 8 (27.5%) pairs and lower echocardiography scores in 6 (20.6%) pairs. Differences were not significant (p=0.129, p=0.801). Conclusions. Cardiac status was similar for women with CHD and ≥3 live births compared to women with <3 live births. Keywords. Pregnancy, Birth, Congenital Heart Disease (CHD), NYHA, Parity.