Neonatal Outcomes in Maternal Heart Disease: A Multidisciplinary Approach toward Congenital and Acquired Conditions

Background: Neonatal outcomes are directly affected by maternal heart disease, which remains one of the leading causes of preventable pregnancy-related deaths in the United States. Limited data compares maternal and neonatal outcomes among this high-risk population. We describe neonatal outcomes among pregnancies with and without heart disease in a tertiary care center with coordinated multidisciplinary care. Methods: This was a cohort study of pregnancies affected by maternal cardiac diseases that received multidisciplinary care (maternal-fetal-medicine, obstetrics, cardiology, anesthesiology, genetics) in a single tertiary center between 2012 and 2024. Study groups consisted of pregnancies with maternal acquired heart disease (AHD) (n = 242), maternal congenital heart disease (CHD) (n = 224), and a comparison group of pregnancies without maternal heart disease from November 2020 through April 2021 (n = 183). Neonatal outcomes including birth weight, gestational age, Apgar scores, and NICU admissions, were compared by Pearson Chi-Square, Fisher Exact, and Kruskal-Wallis rank sum tests. A pairwise comparison was conducted for significant differences. A sensitivity analysis was performed by logistic and linear regression to adjust for beta-blocker use during pregnancy. Significance was set at alpha = 0.05. Results: Maternal heart disease, particularly CHD, was associated with increased adverse neonatal outcomes compared to the comparison cohort. Infants born to people with CHD or AHD had lower birth weights, shorter gestational ages, lower Apgar scores, and higher NICU admission rates compared to those without heart disease (Table 1) (p < 0.01 for all comparisons). The proportion of small for gestational age infants born to people with CHD was significantly higher than those born to people with AHD (p = 0.007). After adjusting for beta-blocker exposure during pregnancy, the odds for small for gestational age in neonates of patients with CHD were 2.29 times higher than in those with AHD (p = 0.006). All other outcomes were similar in the CHD and AHD cohorts. Conclusion: Maternal heart disease is associated with increased risk of adverse neonatal outcomes, necessitating a multidisciplinary approach in prenatal care. Infants born to individuals with CHD had a higher risk for small for gestational age compared to those with AHD. Further studies are needed to better understand this biological difference.