Outcomes Associated With Paroxysmal Supraventricular Tachycardia During Pregnancy.

Paroxysmal supraventricular tachycardia (PSVT) is the most common symptomatic arrhythmia during pregnancy.1 Although PSVT is usually considered transient and harmless, its association with maternal and fetal outcomes during pregnancy are unknown.2–4 In this study, we used a national population cohort to measure the associations between PSVT events during pregnancy and maternal or fetal outcomes and to evaluate the associations between prior ablation of PSVT and those outcomes. This study was approved by the Institutional Review Board of Chang Gung Memorial Hospital, Taiwan. We obtained records of all pregnancies in Taiwan between 2001 and 2012 from a national insurance database. Gestational age, birth weight, Apgar score, and fetal outcomes were obtained from Taiwan’s national birth registry to which obstetricians are required by law to report fetal and maternal information. Mothers who were <15 or >44 years of age or who had had congenital heart disease, a gap between deliveries that was <6 months or >20 years, or multiparities were excluded. Informed consent was waived because of anonymous data. Symptomatic PSVT was defined as an emergency department visit or admission with a primary diagnosis of International Classification of Diseases, Ninth Revision code 427.0. A female admission diagnosis of PSVT and an International Classification of Diseases, Ninth Revision procedure code of 37.34 defined a PSVT case with catheter ablation. Maternal adverse outcomes, based on the Centers for Disease Control and Prevention’s severe maternal morbidity composite outcome, included death within 30 days of delivery, severe maternal morbidity, cesarean delivery, induced labor, prolonged hospital stay, and pregnancy-related complications.5 The Centers for Disease Control and Prevention’s fetal adverse outcomes included poor or excessive fetal growth, fetal stress, fetal abnormalities, low birth weight, and stillbirth. We used SAS, version 9.4 (SAS Institute Inc) to calculate odds ratios with 95% confidence intervals using logistic regression for all exposure groups and for each outcome. We analyzed data from 2 350 328 women between 2001 and 2012 categorized into 2 groups. Subjects in the reference group (2 349 559 women) had no PSVT during pregnancy, and those in the PSVT group (769 women) had PSVT during pregnancy. The 2 groups had similar mean age (30 years), race, place of residence, income, occupation, pregnancy calendar years, and Charlson comorbidity index. In comparison with reference subjects, PSVT subjects had a higher adjusted odds for severe maternal morbidity, cesarean delivery, low birth weight, preterm labor, fetal stress, and obvious fetal abnormalities. There was no difference between the 2 groups for pregnancy-related hypertension, preeclampsia, hemorrhages, gestational diabetes, chorioamnionitis, and stillbirth (Figure). Shang-Hung Chang, MD, PhD Chang-Fu Kuo, MD, PhD I-Jun Chou, MD Lai-Chu See, PhD Kuang-Hui Yu, MD Shue-Fen Luo, MD Meng-Jiun Chiou, MS Weiya Zhang, PhD Michael Doherty, MD Ming-Shien Wen, MD Wei-Jan Chen, MD, PhD Yung-Hsin Yeh, MD