Symptoms during pregnancy in primiparous women with congenital heart disease

Figures & data

Figure 1. Overview of participants.

Table 1. Overview of patient characteristics.

	Total	Symptoms	No symptoms	p-value
	n = 465	n = 104	n = 361
Age in years, mean (±SD)	28.6 (5.1)	28.2 (5.0)	28.7 (5.1)	0.33
Family situation n (%)				0.70^a
Living alone	10	3 (30)	7 (70)
Living together	408	91 (23)	317 (78)
Educational level n (%)				0.01
≤12 years	223	61 (27)	162 (73)
>12 years	188	32 (17)	156 (83)
BMI, (kg/m^2) mean (±SD)	23.6 (4.1)	23.2 (3.5)	23.7 (4.3)	0.26
Physical activity, n (%)				0.004
≤3 h/week	247	71 (29)	176 (71)
>3 h/week	144	23 (16)	121 (84)
NYHA functional class n (%)				<0.001
I	316	46 (15)	270 (85)
II-III	41	27 (66)	14 (34)
Systemic ventricular function, n (%)				0.25
Impaired	29	9 (31)	20 (69)
Normal	413	88 (21)	325 (79)
CV medications during pregnancy, n (%)				0.26
Yes	65	18 (28)	47 (72)
No	392	84 (21)	308 (79)
EQ5D, mean (±SD)	81.1 (16.2)	68.7 (17.7)	84.6 (14.0)	<0.001
Complexity of the heart disease, n (%)				0.50
Simple lesions	164	37 (23)	127 (77)
Moderate lesions	244	51 (21)	193 (79)
Severe lesions	57	16 (28)	41 (72)

BMI: body mass index ; NYHA: New York Heart Association; CV: cardiovascular; EQ5D: EuroQol-5 dimension questionnaire; SD: standard deviation.

a Fischer’s Exact Test.

Table 2. Overview of congenital heart disease diagnoses.

Diagnosis, n /%)	Total	Symptom	No symptoms
	n = 465	n = 104	n = 361
Atrial septal defect	51	15 (29)	36 (71)
Ventricular septal defect	66	12 (18)	54 (82)
Aortic valve disease	88	19 (22)	69 (78)
Pulmonary valve disease	13	0 (0)	13 (100)
Marfan syndrome	27	3 (11)	24 (89)
Tetralogy of Fallot	25	4 (16)	21 (84)
Coarctation of the aorta	60	10 (17)	50 (83)
Atrioventricular septal defect	13	3 (23)	10 (77)
Ebstein anomaly	8	3 (38)	5 (62)
cc-TGA	4	1 (25)	3 (75)
TGA (arterial switch)	4	1 (25)	3 (75)
TGA (atrial switch)	25	6 (24)	19 (76)
TGA (Rastelli)	1	0	1 (100)
Pulmonary atresia with intact ventricular septum	3	1 (25)	2 (75)
Pulmonary atresia with ventricular septal defect	10	4 (40)	6 (60)
Double outlet right ventricle	5	1 (25)	4 (75)
Fontan/TCPC	5	2 (40)	3 (60)
Truncus arteriosus	1	0	1 (100)
Miscellaneous	31	9 (29)	22 (71)

cc-TGA: congenitally corrected transposition of the great arteries; TCPC: total cavopulmonary connection; TGA: transposition of the great arteries.

Table 3. Distribution of symptoms, divided into groups based on the complexity of the heart disease.

Distribution of symptoms at the visits before pregnancy
	Simple lesions (n = 28)	Moderate lesions (n = 33)	Severe lesions (n = 7)
Edema	0	1	0
Dyspnea	9	10	2
Fatigue	8	6	0
Chest pain	4	1	0
Syncope	1	6	0
Palpitations	12	10	2
Total symptoms	34	34	4
Distribution of symptoms at the visits during the third trimester
	Simple lesions (n = 37)	Moderate lesions (n = 51)	Severe lesions (n = 16)
Edema	4	3	2
Dyspnea	13	17	10
Fatigue	14	14	7
Chest pain	3	0	0
Syncope	0	2	0
Palpitations	16	22	4
Total symptoms	50	58	23
Distribution of symptoms after pregnancy
	Simple lesions (n = 15)	Moderate lesions (n = 18)	Severe lesions (n = 7)
Edema	2	1	0
Dyspnea	3	7	2
Fatigue	6	7	4
Chest pain	3	0	0
Syncope	0	1	0
Palpitations	7	5	4
Total symptoms	21	21	10

Note that a patient could have more than one symptom.

Table 4. Univariable logistic regression analysis with perceived symptoms as dependent variable.

	Wald	OR	95 % CI	p-value
Age in years	0.9	1.0	0.9–1.0	0.34
BMI (kg/m^2)	1.0	1.0	0.9–1.0	0.31
Educational level ≤12 years	6.5	1.9	1.2–3.0	0.01
Physical activity ≤3 h/week	7.9	2.1	1.3–3.6	0.005
Complexity, moderate/severe lesions	0.0	1.0	0.6–1.6	0.99
NYHA > I	43.9	11.3	5.5–23.2	<0.001
Cardiovascular medication, yes	1.7	1.5	0.8–2.7	0.19
Impaired systemic function^a	2.3	1.8	0.8–4.1	0.13

OR: odds ratio; CI: confidence interval; BMI: body mass index; NYHA: New York Heart Association; p < 0.05.

a Not included in multivariable analysis due to small numbers.

Table 5. Multivariable model with variables associated with perceived symptoms.

	Initial model				Final model
	Wald	OR	95 % CI	p-value	Wald	OR	95 % CI	p-value
Age	0.5	1.0	0.9–1.0	0.46
Educational level ≤12 years	1.5	1.6	0.8–3.2	0.22
Physical activity ≤3 h/week	5.6	2.4	1.2–5.0	0.02	4.4	2.0	1.1–3.9	0.04
NYHA > I	33.5	11.3	5.0–25.6	<0.001	37.12	10.30	4.9–21.8	<0.001

OR: odds ratio; CI: confidence interval; NYHA: New York Heart Association.

p < 0.05.