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Reproductive patterns and pregnancy outcomes in women with congenital heart disease - a Swedish population-based study
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
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2011 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 6, 659-665 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To study women diagnosed with congenital heart disease (CHD) with respect to characteristics related to their own births, their subsequent likelihood of giving birth and the obstetric and neonatal outcomes of their pregnancies. Design. Population-based register study. Population. All women born in 1973-1983 who were alive and living in Sweden at 13 years of age (n=500 245). Methods. Women diagnosed with CHD (n=2 216) were compared with women without CHD (n=492 476). A total of 188 867 mother-firstborn-offspring pairs were identified and available for analysis. Results. Mothers of women with CHD were more often older and single/unmarried. Women with CHD were more often born preterm or small-for-gestational age (SGA) than women without CHD, more likely to have been born with a cesarean section, to have given birth during the study period, and to be younger at the time of their first pregnancy. Women with CHD were also more prone to give birth to children preterm or SGA and their babies were more often delivered by cesarean section with a higher frequency of congenital abnormality. Conclusions. Women with CHD were more likely to have been born preterm or SGA and these outcomes were repeated in the next generation. Women with CHD should not be discouraged from pregnancy. Prenatal diagnostics should be discussed and offered to these women, as there is an increased risk for congenital abnormalities.

Place, publisher, year, edition, pages
Wiley , 2011. Vol. 90, no 6, 659-665 p.
Keyword [en]
Congenital heart disease; reproduction; high-risk pregnancy
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-69887DOI: 10.1111/j.1600-0412.2011.01100.xISI: 000291433600016OAI: oai:DiVA.org:liu-69887DiVA: diva2:433310
Available from: 2011-08-09 Created: 2011-08-08 Last updated: 2017-12-08
In thesis
1. Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival
Open this publication in new window or tab >>Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Advances in medical treatment during the last 50 years have resulted in more individuals with congenital heart disease (CHD) and Marfan syndrome reaching childbearing age. The substantial physiological changes during pregnancy result in a high-risk situation, and pregnancy is a major concern in women with these conditions.

Aims

  • To describe the socio-demographic characteristics, birth characteristics and reproductive patterns of individuals with CHD and women with Marfan syndrome.
  • To investigate obstetric and neonatal outcomes in the firstborn children of individuals with CHD and women with Marfan syndrome.
  • To study long-term cardiovascular outcomes after childbirth in women with Marfan´syndrome.

Methods

The studies are population-based register studies. The study population in the first paper included all women born between 1973 and 1983 who were alive and resident in Sweden at the age of 13 (494 692 women, of whom 2 216 were women with CHD). In the second paper, the same definition of the study population was chosen, except that it involved all men born between 1973 and 1983 (522 216 men, of whom 2 689 men with CHD). The third and fourth papers involved a study population of all Swedish women born between 1973 and 1993 who were still living in Sweden at age 13. This population consisted of 1 017 538 women, 273 of whom had been diagnosed with Marfan syndrome.

Results and conclusions

The individuals studied were more often born preterm, and were small-for-gestational age babies. They were more likely to have been born by cesarean section. In women with CHD, these characteristics were repeated in their firstborn children. No increased risks were found in children of men with CHD or in children of women with Marfan syndrome. There was no increased risk of aortic dissection in women with Marfan syndrome during pregnancy compared to women with Marfan syndrome who did not give birth. Higher frequencies of cardiac arrhythmia and valvular heart disease were found after childbirth in women with Marfan syndrome. Pregnancy in women with CHD is a high-risk situation associated with increased risk of adverse neonatal outcomes for the expected child. Pregnancy in women without CHD, but where the father has CHD is not so associated with increased risk of adverse obstetric or neonatal outcomes. Pregnancy in women with Marfan syndrome is not associated with adverse outcomes for the expected child.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1565
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology Family Medicine Pediatrics Clinical Science
Identifiers
urn:nbn:se:liu:diva-134854 (URN)10.3384/diss.diva-134854 (DOI)9789176855713 (ISBN)
Public defence
2017-03-24, Föreläsningssal Eken, Campus US, Linköing, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-02-27 Created: 2017-02-27 Last updated: 2017-03-31Bibliographically approved

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Josefsson, AnnNielsen, Niels ErikBladh, MarieSydsjö, Gunilla
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Obstetrics and gynecologyFaculty of Health SciencesDepartment of Gynecology and Obstetrics in LinköpingCardiologyDepartment of Cardiology UHL
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