Assessing Pregnancy, Gestational Complications, and Co-morbidities in Women With Congenital Heart Defects (Data from ICD-9-CM Codes in 3 US Surveillance Sites)

• Authors: Cheryl Raskind-Hood, Emory University; Anita Saraf, Emory University; Tiffany Riehle-Colarusso, Centers for Disease Control and Prevention; Jill Glidewell, Centers for Disease Control and Prevention; Michelle Gurvitz, Massachusetts Department of Public Health; Julie E. Dunn, Massachusetts Department of Public Health; George K. Lui, Stanford University; Alissa Van Zutphen, New York State Department of Health; Claire McGarry, New York State Department of Health; Carol Hogue, Emory University; Trenton Hoffman, Emory University; Fred Rodriguez III, Emory University; Wendy Book, Emory University
• Journal Title: AMERICAN JOURNAL OF CARDIOLOGY
• Volume: Volume 125, Number 5
• Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC | 2020-03-01, Pages 812-819
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.amjcard.2019.12.001
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; DISEASE; POPULATION; ADULTS; STATES; PREVALENCE; OUTCOMES

Abstract

Improved treatment of congenital heart defects (CHDs) has resulted in women with CHDs living to childbearing age. However, no US population-based systems exist to estimate pregnancy frequency or complications among women with CHDs. Cases were identified in multiple data sources from 3 surveillance sites: Emory University (EU) whose catchment area included 5 metropolitan Atlanta counties; Massachusetts Department of Public Health (MA) whose catchment area was statewide; and New York State Department of Health (NY) whose catchment area included 11 counties. Cases were categorized into one of 5 mutually exclusive CHD severity groups collapsed to severe versus not severe; specific ICD-9-CM codes were used to capture pregnancy, gestational complications, and nongestational co-morbidities in women, age 11 to 50 years, with a CHD-related ICD-9-CM code. Pregnancy, CHD severity, demographics, gestational complications, co-morbidities, and insurance status were evaluated. ICD-9-CM codes identified 26,655 women with CHDs, of whom 5,672 (21.3%, range: 12.8% in NY to 22.5% in MA) had codes indicating a pregnancy. Over 3 years, age-adjusted proportion pregnancy rates among women with severe CHDs ranged from 10.0% to 24.6%, and 14.2% to 21.7% for women with nonsevere CHDs. Pregnant women with CHDs of any severity, compared with nonpregnant women with CHDs, reported more noncardiovascular co-morbidities. Insurance type varied by site and pregnancy status. These US population-based, multisite estimates of pregnancy among women with CHD indicate a substantial number of women with CHDs may be experiencing pregnancy and complications. In conclusion, given the growing adult population with CHDs, reproductive health of women with CHD is an important public health issue.