1. Pregnancy outcomes in women with aortic coarctation
- Author
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Karishma P. Ramlakhan, Mark R. Johnson, Matthias Greutmann, Roger Hall, Eric Boersma, Daniel Tobler, Pravin Manga, Markus Schwerzmann, Lucia Baris, Jolien W Roos-Hesselink, Anji T. Yetman, Petros Nihoyannopoulos, Aldo P. Maggioni, Cardiology, Epidemiology, University of Zurich, and Roos-Hesselink, Jolien W
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,610 Medicine & health ,030204 cardiovascular system & hematology ,2705 Cardiology and Cardiovascular Medicine ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Caesarean section ,030212 general & internal medicine ,Extreme Preterm Birth ,Pregnancy ,Ejection fraction ,Eclampsia ,business.industry ,Obstetrics ,Congenital Heart Disease ,medicine.disease ,Haemolysis ,Heart failure ,10209 Clinic for Cardiology ,pregnancy ,Cardiology and Cardiovascular Medicine ,business ,aortic coarctation ,Mace - Abstract
ObjectivePregnancy in women with aortic coarctation (CoA) has an estimated moderately increased risk (mWHO II–III) of adverse cardiovascular, obstetric or fetal events, but prospective data to validate this risk classification are scarce. We examined pregnancy outcomes and identified associations with adverse outcomes.MethodsPregnancies in women with CoA were selected from the worldwide prospective Registry of Pregnancy and Cardiac Disease (ROPAC, n=303 out of 5739), part of the European Society of Cardiology EURObservational Research Programme. The frequency of and associations with major adverse cardiac events (MACE) and hypertensive disorders (pregnancy-induced hypertension, (pre-)eclampsia or haemolysis, elevated liver enzymes and low platelets syndrome) were analysed.ResultsOf 303 pregnancies (mean age 30 years, pregnancy duration 39 weeks), 9.6% involved unrepaired CoA and 27.1% were in women with pre-existing hypertension. No maternal deaths or aortic dissections occurred. MACE occurred in 13 pregnancies (4.3%), of which 10 cases were of heart failure (3.3%). Univariable associations with MACE included prepregnancy clinical signs of heart failure (OR 31.8, 95% CI 6.8 to 147.7), left ventricular ejection fraction 1 (OR 11.4, 95% CI 3.6 to 36.3) and cardiac medication use (OR 4.9, 95% CI 1.3 to 18.3). Hypertensive disorders of pregnancy occurred in 16 (5.3%), cardiac medication use being their only predictor (OR 3.2, 95% CI 1.1 to 9.6). Premature births were 9.1%, caesarean section was performed in 49.7% of pregnancies. Of 4 neonatal deaths, 3 were after spontaneous extreme preterm birth.ConclusionsThe ROPAC data show low MACE and hypertensive disorder rates during pregnancy in women with CoA, suggesting pregnancy to be more safe and better tolerated than previously appreciated.
- Published
- 2021