Cardiac Risks and Management of Complications in Pregnant Women With Congenital Heart Disease

Abstract

There are a growing number of women with congenital heart disease reaching adulthood and contemplating and/or undergoing pregnancy. However, pregnancy imposes hemodynamic stress on the heart and this can result in maternal, fetal and neonatal complications. Most women with congenital heart disease do well during pregnancy, but some women with high-risk cardiac lesions will not tolerate the hemodynamic changes of pregnancy. Physicians must be aware of the potential risks for the mother both during and after pregnancy, the risks to the fetus and neonate, and the risks and benefits of medications and procedures used during pregnancy. For women with complex cardiac conditions, management during pregnancy benefits from multidisciplinary care involving cardiologists with expertise in pregnancy, obstetricians with expertise in maternal fetal medicine, neonatologists and obstetric anesthetists, among others. This review will focus on the cardiac risks faced by women with congenital heart disease; particularly those at high risk, and on management strategies to mitigate risk and address cardiac complications.

Reproductive Health Issues for Adults with a Common Genomic Disorder: 22q11.2 Deletion Syndrome

“…• Optimization of health conditions pre-conception • Reassessment of treatment plan, considering the potential for disease exacerbations from pregnancy, teratogenicity of medications, patient non-adherence, and negative maternal and fetal consequences of untreated morbidities (Negro and Mestman 2011;Seeman 2013;Thorne 2004) • Antenatal care, delivery, neonatal evaluation, and postpartum care in a high-risk obstetric center with an experienced multidisciplinary team Hatton et al 2012;Seeman 2013) • Appropriate screening during pregnancy, including early fetal echocardiogram to screen for congenital heart disease (Rasiah et al 2006) Social support • Awareness of potential sources of conflict between patient and partner/family (Finucane 2010;Karas et al 2014) • Tailoring of support based on the individual patient's needs and his/her existing supports (e.g., social work, child care resources, child protection services, financial resources) (Butcher et al 2012;Finucane 2010;Karas et al 2014) Sexual and reproductive health…”

Management of aortic stenosis in pregnancy

“…(2)(3)(4)(5) Rheumatic AS is another important cause, especially in developing countries. (6) The majority of rheumatic AS is accompanied by rheumatic mitral valve involvement, although rare cases of isolated rheumatic AS have been seen. Supra-and infra-valvular stenoses are less common and their assessment and treatment will not be discussed in this review.…”

“…(3) Previous studies of severe AS in pregnancy site a 17% maternal mortality rate, but a recent report by Silverside and colleagues report no maternal deaths with congenital AS of whom 59% of patients had severe AS. (6,8) Cardiac complications (heart failure and arrhythmias) with severe AS were reported at a rate of ±10%, while cardiac complications in mild/moderate AS are rare. (6) Severe AS is also associated with a higher incidence of preterm labor, intrauterine growth retardation and lower birth weight.…”

“…(6,8) Cardiac complications (heart failure and arrhythmias) with severe AS were reported at a rate of ±10%, while cardiac complications in mild/moderate AS are rare. (6) Severe AS is also associated with a higher incidence of preterm labor, intrauterine growth retardation and lower birth weight. (1,8) The onset of symptoms in patients during pregnancy usually manifests around 20 weeks gestation when the haemodynamic load on the heart significantly increases.…”

“…However, although the maternal mortality is low (<1%) the risk of maternal cardiac and fetal complications is higher than in patients with mild/moderate AS. (6) Patients with moderate or mild AS tolerate pregnancy well. It is important to remember mild or moderate AS should not cause symptoms in nonpregnant patients.…”