{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T16:03:56Z","timestamp":1791302636341,"version":"4.1.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T00:00:00Z","timestamp":1700092800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013491","name":"Jane och Dan Olssons Stiftelse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013491","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>During pregnancy and delivery, hemodynamics are altered and complex congenital heart disease has been associated with adverse maternal and neonatal outcomes. We sought to investigate pregnancy outcome and complications in relation to complexity of heart condition.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>We studied women with ACHD discussed at multidisciplinary conferences at Lund University Hospital March 2009-May 2021. We studied 149 pregnancies in 101 women. We scored each woman retrospectively according to the modified World Health Organization (mWHO) risk classification and included patients in risk class I (n = 36, 24.1%), II (n = 43, 28.9%), II-III (n = 43, 28.9%), III (n = 24, 16.1%) and IV (n = 3, 2.0%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Women with mWHO class \u2265III underwent cesarean section more often than women in less complex mWHO classes, (OR, 5.1; 95% CI, 2.0\u201312.5; <jats:italic>p<\/jats:italic>&lt;0.001). The odds of premature delivery were significantly higher among pregnant women with mWHO class \u2265III (OR, 6.7; 95% CI, 2.6\u201317.4; <jats:italic>p<\/jats:italic>&lt;0.001). We found no difference in incidence of preeclampsia, gestational hypertension, gestational diabetes, hemorrhage &gt;1000 ml or cardiac defect in the neonate depending on WHO-class. Women in mWHO classes III-IV had a higher rate of fetal growth restriction (FGR) compared to women in mWHO classes I, II, II-III (p&lt;0.007).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our findings indicate that women with more complex heart disease (mWHO classes III or IV) tend to have a higher rate of cesarean section, premature birth and FGR.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0294323","type":"journal-article","created":{"date-parts":[[2023,11,16]],"date-time":"2023-11-16T18:34:34Z","timestamp":1700159674000},"page":"e0294323","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":11,"title":["Increased cesarean section rate and premature birth according to modified WHO maternal cardiovascular risk in pregnant women with congenital heart disease"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6257-7655","authenticated-orcid":true,"given":"Frida","family":"Wedlund","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"von Wowern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Hlebowicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,16]]},"reference":[{"issue":"12","key":"pone.0294323.ref001","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1161\/CIRCULATIONAHA.122.060834","article-title":"Adults With Congenital Heart Disease: Trends in Event-Free Survival Past Middle Age","volume":"147","author":"M Dellborg","year":"2023","journal-title":"Circulation"},{"key":"pone.0294323.ref002","volume-title":"\u00c5rsrapport 2020 \u2010 Nationellt register f\u00f6r medf\u00f6dda hj\u00e4rtsjukdomar","author":"SWEDCON","year":"2021"},{"issue":"37","key":"pone.0294323.ref003","doi-asserted-by":"crossref","first-page":"2491","DOI":"10.1093\/eurheartj\/ehv288","article-title":"Pregnancy in women with congenital heart disease","volume":"36","author":"M Greutmann","year":"2015","journal-title":"Eur Heart J"},{"issue":"34","key":"pone.0294323.ref004","doi-asserted-by":"crossref","first-page":"3165","DOI":"10.1093\/eurheartj\/ehy340","article-title":"2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy","volume":"39","author":"V Regitz-Zagrosek","year":"2018","journal-title":"Eur Heart J"},{"issue":"5","key":"pone.0294323.ref005","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1002\/ejhf.501","article-title":"Global cardiac risk assessment in the Registry Of Pregnancy And Cardiac disease: results of a registry from the European Society of Cardiology","volume":"18","author":"IM van 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Siu","year":"2001","journal-title":"Circulation"},{"issue":"21","key":"pone.0294323.ref009","doi-asserted-by":"crossref","first-page":"e013491","DOI":"10.1161\/JAHA.119.013491","article-title":"Neonatal Risk in Children of Women With Congenital Heart Disease: A Cohort Study With Focus on Socioeconomic Status","volume":"8","author":"S Kloster","year":"2019","journal-title":"J Am Heart Assoc"},{"issue":"2","key":"pone.0294323.ref010","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/AOG.0000000000000973","article-title":"Medical and Obstetric Outcomes Among Pregnant Women With Congenital Heart Disease","volume":"126","author":"JL Thompson","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"47","key":"pone.0294323.ref011","doi-asserted-by":"crossref","first-page":"3848","DOI":"10.1093\/eurheartj\/ehz136","article-title":"Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC)","volume":"40","author":"J Roos-Hesselink","year":"2019","journal-title":"Eur Heart J"},{"issue":"8","key":"pone.0294323.ref012","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1159\/000508649","article-title":"Cardiac Complications during Pregnancy Related to Parity in Women with Congenital Heart Disease","volume":"145","author":"E Furen\u00e4s","year":"2020","journal-title":"Cardiology"},{"key":"pone.0294323.ref013","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.ijcard.2017.04.100","article-title":"Effect of maternal age and cardiac disease severity on outcome of pregnancy in women with congenital heart disease","volume":"243","author":"E Furen\u00e4s","year":"2017","journal-title":"Int J Cardiol"},{"issue":"3","key":"pone.0294323.ref014","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/uog.8850","article-title":"Prevalence of maternal cardiac defects in women with high-resistance uterine artery Doppler 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Ntiloudi","year":"2018","journal-title":"Hellenic J Cardiol"},{"key":"pone.0294323.ref021","unstructured":"L\u00e4kartidningen. 2019,116:FSR7."},{"issue":"12","key":"pone.0294323.ref022","doi-asserted-by":"crossref","first-page":"e0167820","DOI":"10.1371\/journal.pone.0167820","article-title":"Mode of Delivery and Pregnancy Outcome in Women with Congenital Heart Disease","volume":"11","author":"J Hrycyk","year":"2016","journal-title":"PLoS One"},{"key":"pone.0294323.ref023","volume-title":"Graviditetsregistrets \u00c5rsrapport 2021","author":"Graviditetsregistret","year":"2021"},{"key":"pone.0294323.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S104795112300080X","article-title":"Self-reported quality of life before, during, and after pregnancy in women with CHD","author":"F Wedlund","year":"2023","journal-title":"Cardiol Young"},{"issue":"4","key":"pone.0294323.ref025","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1097\/AOG.0b013e31820cab69","article-title":"Effect of maternal heart disease on fetal growth","volume":"117","author":"E Gelson","year":"2011","journal-title":"Obstet Gynecol"},{"issue":"41","key":"pone.0294323.ref026","doi-asserted-by":"crossref","first-page":"4252","DOI":"10.1093\/eurheartj\/ehab571","article-title":"Maternal and neonatal complications in women with congenital heart disease: a nationwide analysis","volume":"42","author":"AE Lammers","year":"2021","journal-title":"Eur Heart J"}],"container-title":["PLOS 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