Table 2.
Estimated Total and Rate (per 10,000 Delivery Hospitalizations) of Medical and Obstetric Complications Among Women With and Without Congenital Heart Disease at Delivery Hospitalization
| Condition or Event | CHD (n=10,660), n (per 10,000 [95% CI]) | No CHD (n=12,513,458), n (per 10,000 [95% CI]) | Adjusted OR* (95% CI) | Population-Attributable Risk Percent† |
|---|---|---|---|---|
| In-hospital mortality | 19 (17.8 [10.7–27.8]) | 892 (0.71 [0.67–0.76]) | 22.10 (13.96–34.97) | 2.0 |
| Composite cardiovascular outcome‡ | 655 (614 [570–662) | 42,887 (34.3 [33.9–34.6]) | 10.54 (9.55–11.64) | 1.4 |
| Mechanical ventilation | 98 (91.9 [74.7–112]) | 8,660 (6.9 [6.8–7.1]) | 9.94 (7.99–12.37) | 1.0 |
| Transfusion | 320 (300 [269–334]) | 129,347 (103 [103–104]) | 2.56 (2.29–2.89) | 0.2 |
| Cardiac events | ||||
| Myocardial infarction–ischemia | 14 (13.1 [7.2–22.0]) | 366 (0.29 [0.26–0.32]) | 35.49 (20.54–61.33) | 3.6 |
| Cardiac arrest–ventricular fibrillation | 15 (14.1 [7.9–23.2]) | 839 (0.67 [0.63–0.72]) | 13.4 (7.22–24.86) | 1.7 |
| Arrhythmia | 453 (425 [387–465]) | 36,641 (29.3 [29.0–29.6]) | 11.70 (10.50–13.03) | 4.1 |
| Acute heart failure | 184 (173 [149–199]) | 4,254 (3.4 [3.3–3.5]) | 35.42 (29.89–41.98) | 1.1 |
| Pulmonary events | ||||
| Pneumonia | 69 (64.7 [50.4–81.8]) | 11,821 (9.4 [9.3–9.6]) | 5.06 (3.87–6.61) | 0.5 |
| Pulmonary edema | 11 (10.3 [5.2–18.5]) | 1,997 (1.6 [1.5–1.7]) | 2.85 (1.22–6.64) | 0.5 |
| Acute respiratory distress syndrome | 34 (31.9 [22.1–44.5]) | 2,791 (2.2 [2.1–2.3]) | 12.44 (8.83–17.52) | 1.1 |
| Thromboembolic events | ||||
| Pulmonary embolism | 35 (32.8 [22.9–45.6]) | 3,405 (2.7 [2.6–2.8]) | 9.74 (6.95–13.64) | 0.9 |
| Deep vein thrombosis | 20 (18.8 [11.5–29.0]) | 6,165 (4.9 [4.8–5.1]) | 3.15 (2.01–4.92) | 0.2 |
| Stroke–cerebrovascular accident | 39 (36.6 [26.0–50.0]) | 1,720 (1.4 [1.3–1.4]) | 22.23 (16.09–30.73) | 2.1 |
| Infections | ||||
| Sepsis | 24 (22.5 [14.4–33.5]) | 6,280 (5.0 [4.9–5.1]) | 3.50 (2.22–5.51) | 0.3 |
| Renal event | ||||
| Acute renal failure | 31 (29.1 [19.8–41.3]) | 6,873 (5.5 [5.4–5.6]) | 2.68 (1.73–4.15) | 0.4 |
| Obstetric events | ||||
| Cesarean delivery§ | 4,335 (4,067 [3,973–4,161]) | 4,037,021 (3,226 [3,223–3,229]) 1.36 (1.30–1.42) | 0.02 | |
| Operative vaginal delivery§ | 984 (923 [869–980]) | 791,259 (632 [631–634]) | 1.54 (1.44–1.66) | 0.04 |
| Gestational diabetes | 669 (628 [582–675]) | 708,403 (566 [565–567]) | 1.17 (1.07–1.27) | 0.01 |
| Hypertensive disorders in pregnancy | 948 (889 [836–945]) | 922,514 (737 [736–739]) | 1.05 (0.97–1.13) | 0.02 |
| Fetal growth restriction | 525 (492 [452–535]) | 270,954 (216 [216–217]) | 2.08 (1.88–2.30) | 0.11 |
| Stillbirth | 58 (54.4 [41.3–70.3]) | 51,016 (40.8 [40.4–41.1]) | 1.50 (1.16–1.94) | 0.03 |
| Preterm labor | 1,423 (1,335 [1,271–1,401]) | 1,016,901 (813 [811–814]) | 1.66 (1.56–1.77) | 0.05 |
| Placental abruption | 178 (167 [143–193]) | 134,591 (108 [107–108]) | 1.54 (1.32–1.80) | 0.05 |
| Postpartum hemorrhage | 384 (360 [326–397]) | 319,079 (255 [254–256]) | 1.38 (1.24–1.54) | 0.04 |
| Chorioamnionitis | 260 (244 [215–275]) | 323,216 (258 [257–259]) | 0.91 (0.79–1.04) | 0.00 |
CHD, congenital heart disease; CI, confidence interval; OR, odds ratio.
Data are n (/10,000 [95% CI]) unless otherwise specified.
Adjusted ORs for each outcome associated with CHD and population-attributable risk percent for each outcome attributed to delivery hospitalizations with CHD, Nationwide Inpatient Sample, 2008–2010.
OR adjusted for age, race–ethnicity, insurance status, multiple gestation, mode of delivery, asthma, diabetes, thyroid disorders, systemic lupus erythematosus, rheumatoid arthritis–collagen vascular disease, human immunodeficiency virus, thrombophilia–antiphospholipid antibody syndrome, anemia, thrombocytopenia, drug use, alcohol use, tobacco, chronic hypertension, and chronic renal failure. Referent group is hospitalizations in women without CHD.
Population-attributable risk percent was calculated using the equation: PAR, Pe (RRe−1)/[1+Pe (RRe−1)], where PAR, population-attributable risk; Pe, prevalence of the exposure; and RRe, relative risk of disease resulting from the exposure.22
Cardiovascular composite outcome includes in-hospital mortality, myocardial infarction, cardiac arrest, arrhythmia, heart failure, or stroke.
Mode of delivery not controlled for in calculating adjusted OR for cesarean and operative vaginal delivery.