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Pregnancy in Women With Unrepaired Congenital Heart Disease
Study Questions:
What are the maternal and fetal outcomes in women with uncorrected congenital heart disease (CHD)?
Methods:
The European Society of Cardiology EORP ROPAC (EURObservational Research Programme Registry of Pregnancy and Cardiac disease) registry was used to study outcomes of pregnancy in women with heart disease over a 10-year time period.
Results:
Of 5,739 pregnancies in 53 countries, 3,295 women had CHD, of which 1,059 had not undergone correction. Underlying cardiac defects differed in patients with corrected CHD as compared with uncorrected CHD. Maternal mortality and heart failure in the women with uncorrected CHD were 0.7% and 8.7%, respectively. Eisenmenger syndrome was associated with a very high risk of cardiac events (65.5%), maternal mortality (10.3%), and heart failure (48.3%). Women from emerging countries had higher pre-pregnancy signs of heart failure, pulmonary hypertension, and cyanosis (p < 0.001) and worse maternal and fetal outcomes, with a threefold higher rate of hospital admissions for cardiac events and intrauterine growth restriction.
Conclusions:
There are significant differences in congenital cardiac diagnoses in pregnant patients with uncorrected CHD as compared with those with corrected CHD. Women with uncorrected CHD, particularly those with Eisenmenger syndrome and those from emerging countries, had worse outcomes.
Perspective:
This study made use of the EORP ROPAC registry to study pregnancy outcomes in women with uncorrected CHD. Mortality in these patients was relatively low, at 0.7%. This is in the setting of a relatively large number of patients with pulmonary hypertension related to CHD. Morbidity was quite high, particularly in patients with Eisenmenger syndrome. One specific limitation of the study is the fact that many pregnant patients were managed in specialized centers, which may limit generalizability of the study to the global population. The world-wide care of pregnant women with congenital heart surgery will continue to evolve as more women have access to cardiac interventions early in life. This will likely result in more patients with corrected disease, but also in more patients with palliated complex disease.
Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Congenital Heart Disease, CHD and Pediatrics and Prevention, Acute Heart Failure, Pulmonary Hypertension, Hypertension
Keywords: Cyanosis, Eisenmenger Complex, Fetal Growth Retardation, Heart Defects, Congenital, Heart Failure, Hypertension, Pulmonary, Maternal Mortality, Pregnancy, Pregnancy Outcome, Women
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