Pregnancy in Women with Complex Congenital Heart Disease. A Constant Challenge

Abstract

Background: The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions. Objectives: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. Methods: During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 ± 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p < 0.05. Results: Only seventeen (40.5%) pregnancies had maternal and fetal uneventful courses. There were 13 (30.9%) maternal complications, two (4.7%) maternal deaths due to hemorrhage pos-partum and severe pre-eclampsia, both of them in women with hypoxemia. There were 7 (16.6%) stillbirths and 17 (40.5%) premature babies. Congenital heart disease was identified in two (4.1%) infants. Maternal and fetal complications were higher (p < 0.05) in women with hypoxemia. Conclusions: Pregnancy in women with CCC was associated to high maternal and offspring risks. Hypoxemia was a predictive variable of poor maternal and fetal outcomes. Women with CCC should be advised against pregnancy, even when treated in specialized care centers.

Pregnancy Complications and Outcomes Among Women With Congenital Heart Disease in Beijing, China

“…Our results suggest that the risk of the most adverse events during delivery was not significantly different in women with different CHD severities, and this may have been because the differences in risk were not fully established. This finding was not consistent with that of Avila et al (12,13) who argued that pregnancy in women with complex (severe) CHD was associated with high maternal and offspring risks.…”

Maternal and perinatal outcome in heart disease complicating pregnancy

“…2 Hemodynamic changes taking place during pregnancy are generally well tolerated in healthy women but in cases where there is a pre-existing congenital or acquired heart disease there is a considerable risk of maternal as well as fetal morbidity and in cases of complex congenital heart diseases there is significant risk of maternal mortality. 3 Unrecognized heart diseases remain one of the biggest concerns faced by obstetricians in developing world. In considerable number of women, the heart disease remains unrecognized only to be diagnosed during later stages of pregnancy.…”

Cardiovascular diseases worsen the maternal prognosis of COVID-19

“…Maternal mortality in patients with CVD is high, with significant variations according to their baseline CVD, which ranges from 1 to 5%. However, this population always have a higher mortality compared with the general population (19,(26)(27)(28). In the context of the COVID-19 pandemic, the presence of CVD has been recognized as a risk factor for death in several studies and meta-analyses that considered the general population, with incidence of CVD in 37 to 69% of hospitalized cases and lethality rate of 10.5 to 15.5% (29,30).…”