Objective. Women with congenital heart disease (CHD) are at risk for cardiac deterioration. Previous studies focused on women after one or two pregnancies. We investigated the effect of parity on maternal cardiac status by comparing women with CHD and ≥3 live births to women with <3 live births. Design. Matched case-controlled study. Setting. Tertiary medical center, clinic for adults with CHD. Population. Twenty-nine women with ≥3 live births, matched (CHD, age) with women with <3 live births. Methods. Women with CHD were identified from the Adult CHD clinic (2010-2018), and data retrieved from medical records. Outcomes were compared for women with ≥3 live births versus <3 live births using the McNemar test. Main outcome measures. New York Heart Association (NYHA) functional classification, and cardiac impairment score assigned according to echocardiography by a cardiologist blinded to parity. Results. For 29 matched pairs with mean age 42.4 (SD 14.2) and 186 live births, the mean difference in number of live births between matched pairs was 3.8 (SD 2.5). In 17 (58.6%) pairs, women with ≥3 live births and those with <3 live births had concordant NYHA class. Echocardiography score was concordant for 19 (65.5%) pairs. Women with ≥3 live births had lower NYHA class in 8 (27.5%) pairs and lower echocardiography scores in 6 (20.6%) pairs. Differences were not significant (p=0.129, p=0.801). Conclusions. Cardiac status was similar for women with CHD and ≥3 live births compared to women with <3 live births. Keywords. Pregnancy, Birth, Congenital Heart Disease (CHD), NYHA, Parity.

Background: Less invasive forms of ventilation have evolved aiming to decrease bronchopulmonary Dysplasia (BPD) morbidity. It is unclear whether changes in ventilation practices have been associated with improvements in respiratory outcomes. Objective: To examine trends of ventilation modes in preterm neonates over the last decade and their impact on BPD. Methods: A retrospective chart review of very low birth weight infants (VLBW) and those born at less than 32 weeks gestation hospitalized during two periods: the years 2012-2013 and 2018-2019. The primary outcome was the prevalence of BPD. Study variables included the mode and duration of ventilation, duration of oxygen need, and perinatal clinical parameters. Results: Four hundred eighty-one infants were enrolled. Between the two study periods, a significant increase was observed in invasive (33% to 47%, p=0.002), and non-invasive ventilation rates (44% to 72%, p<0.001). The average duration of non-invasive ventilation increased significantly (from 9.24 to 14.08 days, p=0.016). The total duration of respiratory support remained unchanged. The overall prevalence of moderate and severe BPD at 36 weeks corrected age remained approximately 40% in preterm infants born at less than 28 weeks gestation. Conclusion: The increasing use of non-invasive ventilation was not accompanied by a reduction in the use of invasive ventilation, nor by a reduced prevalence of BPD. The high prevalence of BPD remains a significant problem in preterm infants born < 28 weeks of age. Other interventions, in addition to less aggressive ventilation, need to be explored.