Consensus Document of the Italian Association of Hospital Cardiologists (ANMCO), Italian Society of Pediatric Cardiology (SICP), and Italian Society of Gynaecologists and Obstetrics (SIGO): pregnancy and congenital heart diseases

Abstract

The success of cardiac surgery over the past 50 years has increased numbers and median age of survivors with congenital heart disease (CHD). Adults now represent two-thirds of patients with CHD; in the USA alone the number is estimated to exceed 1 million. In this population, many affected women reach reproductive age and wish to have children. While in many CHD patients pregnancy can be accomplished successfully, some special situations with complex anatomy, iatrogenic or residual pathology are associated with an increased risk of severe maternal and fetal complications. Pre-conception counselling allows women to come to truly informed choices. Risk stratification tools can also help high-risk women to eventually renounce to pregnancy and to adopt safe contraception options. Once pregnant, women identified as intermediate or high risk should receive multidisciplinary care involving a cardiologist, an obstetrician and an anesthesiologist with specific expertise in managing this peculiar medical challenge.This document is intended to provide cardiologists working in hospitals where an Obstetrics and Gynecology Department is available with a streamlined and practical tool, useful for them to select the best management strategies to deal with a woman affected by CHD who desires to plan pregnancy or is already pregnant.

Management of People With a Fontan Circulation: a Cardiac Society of Australia and New Zealand Position statement

“…Women who are not receiving anticoagulation therapy, or in whom a right-to-left shunt exists, should avoid using the combined oral contraceptive pill (COCP, commonly known as ''the pill") [176][177][178] because of its oestrogenassociated thromboembolic risk and the availability of effective alternatives. Progesterone-only formulations are considered safe.…”

Exploring the lived experiences of pregnancy and early motherhood in Italian women with congenital heart disease: an interpretative phenomenological analysis

“…Overall, the number of women with CHD who are becoming pregnant is increasing worldwide 11. In this population, pregnancy is typically contraindicated, and consistent contraception use is widely recommended by clinicians12: in fact, the haemodynamic changes associated with pregnancy could negatively affect women with CHD as well as their offspring,13 even in cases of women with simple and moderate CHD who could exhibit sufficient cardiac reserve to successfully tolerate the physiological changes related to pregnancy 14 15. Overall, the risk of complications is broadly associated with the complexity of CHD and diverse risk factors, such as lifestyles 13…”

“…Furthermore, pregnant women with CHD often experience feelings of fear for themselves and for their future offspring 16. For these patients, the multidisciplinary case management of pregnancy and early motherhood is crucial for the achievement of better health outcomes and the guarantee of their safety 13 17. A sound case management approach requires a clear understanding of the patients’ in-depth experiences during pregnancy and early motherhood 9 18.…”

Maternal and Perinatal Risk Stratification in Cardiovascular Pathology. A Modern View on the Problem

“…Стратифікація вагітних (або жінок фертильного віку) за класами кардіоваскулярного ризику дозволяє вибудувати чітку програму спостереження та медич- Генетичне консультування -важливий етап передконцепційного обстеження жінки з ВВС, СЗГА тощо [11,20].…”

“…Якщо виявлено генетичне походження ВВС, оцінюється ризик передачі патології нащадкам: якщо виявлено ризик передачі генетичного дефекту, жінці пропонується можливість інвазивного пренатального тестування (біопсія хоріона або амніоцентез) на генетичну аномалію. У матерів з ізольованою ВВС ризик появи її у дітей становить близько 3-5 %, при цьому вищий ризик виникнення синдромів обструкції лівих відділів серця, включаючи синдром гіпоплазії лівих відділів серця [20].…”