High prevalence of pre-eclampsia in women with coarctation of the aorta

Abstract

Objective To study pregnancy outcomes in women with coarctation of the aorta (CoA) and associations to hypertensive disorders of pregnancy. Background Maternal morbidity and mortality are higher in women with heart disease and preeclampsia. Chronic hypertension, frequently encountered in CoA, is a risk factor for preeclampsia. Methods Clinical data from the National Unit for Pregnancy and Heart Disease database was reviewed for pregnant women with CoA from 2008 to 2021. The primary outcome was hypertensive pregnancy disorders. The secondary outcomes were other cardiovascular, obstetric, and fetal complications. Results Seventy-six patients were included, with a total of eighty-seven pregnancies. Seventeen (20%) patients were treated for chronic hypertension before pregnancy. Fifteen (20%) patients developed preeclampsia, and five (7%) had pregnancy-induced hypertension. Major adverse cardiac events developed in four (5%) patients, with no maternal or fetal mortality. Maternal age at first pregnancy (Odds ratio (OR) 1.37), BMI before first pregnancy (OR 1.77) and using ASA from the first trimester (OR 0.22) was statistically significantly associated with preeclampsia. At follow-up (median) eight years after pregnancy, twenty-nine (38%) patients had antihypertensive treatment, an increase of 16% compared to pre-pregnancy. Five (7%) patients had progression of aorta ascendens dilatation to >40mm, seven (9%) had an upper to lower systolic blood pressure BP gradient >20 mmHg, and six (8%) had received CoA reintervention. Conclusions Preeclampsia occurred in 20% of women with CoA in their first pregnancy. All preeclamptic patients received adequate antihypertensive treatment. All CoA patients was provided multidisciplinary management, including cardiologic follow-up, to optimize maternal-fetal outcomes.

High-Risk Congenital Heart Disease in Pregnancy

“…22 For women with coarctation of the aorta desiring pregnancy, the primary concern is the development of hypertension and preeclampsia. 25 Women with unrepaired coarctation of the aorta are at risk of aortic dissection at the site of the narrowing and hypoperfusion of the placenta and limited fetal growth due to restricted blood supply to the lower part of the body. There are reports of a higher incidence of miscarriages in women with repaired coarctation versus controls.…”

Congenital heart disease: types, pathophysiology, diagnosis, and treatment options

“…The maternal mortality is significantly higher in patients with a combination of heart disease and preeclampsia than in pregnant women without cardiovascular disease. 186 In 2022, the ESC Registry of Pregnancy and Cardiac Disease study reported a maternal mortality of 3.5% in patients with heart disease and preeclampsia. All deaths associated with preeclampsia occurred during the postpartum period, and 50% were attributed to heart failure.…”

“…187 A recent study reported that preeclampsia occurred in 20% of patients with CoA during their first pregnancy, suggesting an elevated risk of developing preeclampsia than in the healthy pregnant population. 186…”