Clinical Obstetrics
Poster Session 4
Rula Atwani, MD
Research Fellow
Eastern Virginia Medical School
Norfolk, VA, United States
Michael M. Aziz, MD, MPH (he/him/his)
Physician
Allegheny Health Network
Pittsburgh, PA, United States
George R. Saade, MD (he/him/his)
Professor & Chair of Ob-Gyn
Eastern Virginia Medical School
Norfolk, VA, United States
Tetsuya Kawakita, MD, MS
Assistant Professor
Eastern Virginia Medical School
Norfolk, VA, United States
To evaluate relationships between congenital malformation types and adverse maternal outcomes.
Study Design:
This was a repeated cross-sectional analysis of US vital statistics Live Birth/Infant Death linked data from 2011 to 2020. All pregnancies at 20 weeks or greater were included. Our primary outcome was severe maternal morbidity (SMM) defined as any maternal intensive care unit admission, transfusion, uterine rupture, and hysterectomy. Secondary outcomes were cesarean delivery (CD), preeclampsia, and preterm delivery. Pregnancy outcomes were compared for each type of congenital malformation with the referent group of pregnancies without congenital malformation. Congenital malformations available in the dataset included spina bifida, congenital heart disease, diaphragmatic hernia, omphalocele, gastroschisis, limb defect, cleft lip/palate, chromosomal anomaly, and hypospadias. If a fetus had more than one malformation, it was classified as multiple malformation. Adjusted relative risks (aRR) with 99% confidence intervals were calculated using modified Poisson regression.
Results:
Of 34,747,260 pregnancies that were included in our study, 34,645,400 pregnancies had no congenital malformation and 101,860 had isolated or multiple congenital malformation. Outcomes are presented in Table 1. Compared to pregnancies without congenital malformation, all congenital malformations were associated with an increased risk of SMM except for gastroschisis and limb anomaly (range of aRR 1.60-2.66). All malformations were associated with an increased risk of CD and preterm delivery (range of aRR 1.14-2.36 and 1.64-7.91, respectively). Congenital heart disease, omphalocele, cleft lip/palate, chromosomal anomaly, hypospadias, and multiple malformation were associated with an increased risk of preeclampsia (range of aRR 1.24-1.63) and gastroschisis was associated with a decreased risk of preeclampsia (aRR 0.52).
Conclusion:
The maternal implications of congenital malformation should be included in informed consent when making decisions
regarding continuation of pregnancy.