Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 1;179(2):163-170.
doi: 10.1001/jamapediatrics.2024.5073.

Adverse Obstetric Outcomes in Pregnancies With Major Fetal Congenital Heart Defects

Gitte Hedermann  1   2   3 , Paula L Hedley  1   4 , Kasper Gadsbøll  5 , Ida N Thagaard  1   6 , Lone Krebs  7   8 , Mona Aarenstrup Karlsen  2 , Cathrine Vedel  5 , Line Rode  5 , Michael Christiansen  1   4   9 , Charlotte K Ekelund  5   8
Affiliations

Adverse Obstetric Outcomes in Pregnancies With Major Fetal Congenital Heart Defects

Gitte Hedermann et al. JAMA Pediatr. .

Abstract

Importance: Understanding the risk profile of obstetric complications in pregnancies with fetal major congenital heart defects (MCHDs) is crucial for obstetric counseling and care.

Objective: To investigate the risk of placenta-related adverse obstetric outcomes in pregnancies complicated by fetal MCHDs.

Design, setting, and participants: This cohort study retrieved data from June 1, 2008, to June 1, 2018, from the Danish Fetal Medicine Database, which includes comprehensive data on more than 95% of all pregnancies in Denmark since the database was instituted in 2008. All singleton pregnancies that resulted in a live-born child after 24 weeks' gestation without chromosomal aberrations were included. A systematic search of the literature was performed in PubMed, Embase, and the Cochrane Library from inception to June 1, 2024, to compile existing knowledge and data on adverse obstetric outcomes among MCHD subtypes.

Exposure: Fetal MCHDs including 1 of 11 subtypes.

Main outcomes and measures: The primary outcome was a composite adverse obstetric outcome defined as preeclampsia, preterm birth, fetal growth restriction, or placental abruption. Secondary outcomes consisted of each adverse obstetric event. Adjusted odds ratios (AORs) were computed using generalized estimating equations adjusted for maternal body mass index, age, smoking, and year of delivery. Meta-analyses were conducted using random-effects models to pool effect sizes for each MCHD subtype and adverse obstetric outcome.

Results: A total of 534 170 pregnancies were included in the Danish cohort, including 745 with isolated fetal MCHDs (median [IQR] maternal age, 29.0 [26.0-33.0] years) and 533 425 without MCHDs (median [IQR] maternal age, 30.0 [26.0-33.0] years). Pregnancies with fetal MCHDs exhibited a higher rate of adverse obstetric outcomes at 22.8% compared with 9.0% in pregnancies without fetal MCHDs (AOR, 2.96; 95% CI, 2.49-3.53). Preeclampsia (AOR, 1.83; 95% CI, 1.33-2.51), preterm birth at less than 37 weeks (AOR, 3.84; 95% CI, 3.15-4.71), and fetal growth restriction (AOR, 3.25; 95% CI, 2.42-4.38) occurred significantly more frequently in pregnancies with MCHDs. Except for fetal transposition of the great arteries (AOR, 1.19; 95% CI, 0.66-2.15), all MCHD subtypes carried a greater risk of adverse obstetric outcomes. The meta-analysis included 10 additional studies that supported these results.

Conclusions and relevance: These findings suggest that nearly 1 in 4 women expecting a child with an MCHD, except transposition of the great arteries, may be at high risk of adverse obstetric outcomes.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Ekelund reported receiving grants from the Danish Children Heart Foundation during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Composite Adverse Obstetric Outcome by Major Fetal Congenital Heart Defect Subtype in Singleton Pregnancies, Denmark 2008-2018
Odds ratios (ORs) were adjusted for maternal age, maternal body mass index, smoking during pregnancy, and delivery year. AVSD indicates atrioventricular septal defect; CCTGA, congenitally corrected transposition of the great arteries; COA, coarctation of the aorta; DORV, double outlet right ventricle; MCHD, major congenital heart defect; PA-IVS, pulmonary atresia with intact ventricular septum; PA-VSD, pulmonary atresia with ventricular septal defect; TA, truncus arteriosus; TGA, transposition of the great arteries; TOF, tetralogy of Fallot; UVH, univentricular heart.
See this image and copyright information in PMC

References

    1. Courtney JA, Cnota JF, Jones HN. The role of abnormal placentation in congenital heart disease; cause, correlate, or consequence? Front Physiol. 2018;9:1045. doi: 10.3389/fphys.2018.01045 - DOI - PMC - PubMed
    1. Snoep MC, Aliasi M, van der Meeren LE, Jongbloed MRM, DeRuiter MC, Haak MC. Placenta morphology and biomarkers in pregnancies with congenital heart disease—a systematic review. Placenta. 2021;112:189-196. doi: 10.1016/j.placenta.2021.07.297 - DOI - PubMed
    1. Sood E, Newburger JW, Anixt JS, et al. ; American Heart Association Council on Lifelong Congenital Heart Disease and Heart Health in the Young and the Council on Cardiovascular and Stroke Nursing . Neurodevelopmental outcomes for individuals with congenital heart disease: updates in neuroprotection, risk-stratification, evaluation, and management: a scientific statement from the American Heart Association. Circulation. 2024;149(13):e997-e1022. doi: 10.1161/CIR.0000000000001211 - DOI - PubMed
    1. Steurer MA, Baer RJ, Keller RL, et al. Gestational age and outcomes in critical congenital heart disease. Pediatrics. 2017;140(4):e20170999. doi: 10.1542/peds.2017-0999 - DOI - PubMed
    1. Steurer MA, Peyvandi S, Costello JM, et al. Association between Z-score for birth weight and postoperative outcomes in neonates and infants with congenital heart disease. J Thorac Cardiovasc Surg. 2021;162(6):1838-1847.e4. doi: 10.1016/j.jtcvs.2021.01.065 - DOI - PubMed