(1023) Preterm premature rupture in patients with adult congenital heart disease

Women with adult congenital heart disease (ACHD) are at risk for endocarditis in labor. We sought to identify whether rates of preterm premature rupture of membranes (PPROM) were higher, potentially increasing risk of bacterial exposure in these patients.

 


Study Design:

This is a retrospective cohort study evaluating pregnant patients with a delivery encounter in the National Inpatient Sample database through AHRQ-HCUP from 2017 to 2019. Women were included if they delivered greater than 20 weeks gestation and excluded if gestational age at delivery was unknown or the hospital encounter was not linked to a delivery.  Women with ICD10 codes specific to congenital heart disease were compared to those without. The primary outcome was PPROM. Secondary outcomes included PPROM and delivery at less than 34 and 28 weeks as well as other infectious morbidity including endocarditis. T-tests, chi2 analysis, and logistic regression were used to compare groups. 

 


Results: A total of >2.2 million subjects were included with 2,409 affected by ACHD. ACHD subjects were more likely to identify as non-Hispanic white, be younger, obese, privately insured and have more comorbidities (p< 0.05). They also delivered at larger, urban teaching and private hospitals (p< 0.05) via cesarean (39.5% vs 33.1%) (p< 0.001). Rates of PPROM overall (3.2% vs 1.7%, p< 0.001) and at < 37 weeks and < 34 weeks gestation (3.1% vs 1.6 and 1.6% vs 0.7%, respectively) was higher in those with ACHD. Rates of endocarditis were significantly higher (0.3% vs < 0.0%, p< 0.001) and so were rates of endometritis and other postpartum infections, but not chorioamnionitis. PPROM at less than 37 weeks, endocarditis, endometritis and other infections remained significantly associated with ACHD after controlling for confounders that differed between groups at baseline with p< 0.05.

Conclusion:

ACHD is associated with higher rates of PPROM and other infectious morbidity at the time of delivery admission, including endocarditis.