Delivery outcomes in women with congenital heart disease: results from the Cuban National Programme for pregnancy and heart disease

Objective To inform on delivery outcomes achieved in congenital heart disease (CHD) patients by the Cuban National Programme for pregnancy and heart disease. Methods Single-centre retrospective study on a prospectively collected cardiac pregnancy database at a tertiary referral hospital (January 2000–May 2017). Primary outcomes: pregnancy duration, outcome, maternal/fetal complications. Results Four hundred sixty-seven pregnancies in 462 recorded cases reached third trimester. Median age: 25 (21–29) years. Patients presented in NYHA class I (97%, n = 453) or II (3%, n = 14), 6% ( n = 27) had arrhythmias, 1% ( n = 4) had co-morbidities, 1% ( n = 4) had impaired left ventricular function. There were 464 singleton pregnancies and 3 twin pregnancies. Of the singleton pregnancies, one resulted in stillbirth (0.2%). The rest were live births ( n = 463), median weight 3200 (2900–3421) grams. Median pregnancy duration: 39.1 (38.6–40) weeks. Caesarean rate: 34% ( n = 156). All twin pregnancies ( n = 3) resulted in live births ( n = 6) via caesarean section, of median weight 2710 (2458–2850) grams and median pregnancy duration 37 (36–38) weeks. Maternal cardiovascular complications (< 0.5%, n = 2), and obstetric complications (14%, n = 67) did not result in any mortality. Small-for-gestational-age was the commonest neonatal complication (10%, n = 48), with zero mortality. Three neonates (1%) had CHD. Post-delivery maternal NYHA functional status: class I in 84% ( n = 393), class II in 16% ( n = 73), and class III in one patient (< 0.5%). Conclusion In middle-income countries management of CHD pregnancies according to existing guidelines can achieve good maternal and fetal outcomes.