Effect of maternal heart disease on pregnancy outcomes

Figures & data

Table 1. Right-sided heart lesions.

Volume overload	Pressure overload
Pulmonary regurgitation	Pulmonary stenosis
Ebsteins anomaly of the tricuspid valve	l-TGA
Repaired TOF	d-TGA after atrial switch

d-TGA: Dextro-TGA; l-TGA: Levo-TGA; TGA: Transposition of the great arteries; TOF: Tetralogy of Fallot.

Table 2. Anticoagulation regimes in pregnancy for women with mechanical heart valves.

Regime	Maternal complication			Fetal complications
	Thrombotic events (%)	Death (%)		Fetal anomalies (%)	Fetal wastage (%)
Warfarin until week 35, then heparin until delivery	3.9	1.8		6.4	33.6
Unfractionated heparin until week 13, then warfarin until week 35, then heparin until delivery	9.2	4.2		3.4	26.5
Low-molecular-weight heparin throughout pregnancy	10.6	0		NA	4
Unfractionated heparin throughout pregnancy	33.3	15		0	42.9

With any of the above regimes, consider adjunctive antiplatelet therapy in the second and third trimester.

NA: Not available.

Data taken from [48,49].

Table 3. Risk of congenital heart disease in the offspring of women with heart disease.

Cardiac lesion	Risk of CHD in fetus (%)
	Previous sibling affected	Father affected	Mother affected
Marfan syndrome	–	50	50
Aortic stenosis	2	3	15–17.9
Pulmonary stenosis	2	2	6.5
VSD	3	2	9.5–15.6
ASD	2.5	1.5	4.6–11
PDA	3	2.5	4.1
COA	–	–	14.1
TOF	2.5	1.5	2.6

ASD: Atrial septal defect; CHD: Congenital heart disease; COA: Coarctation of the aorta; PDA: Patent ductur arteriosus; TOF: Tetralogy of Fallot; VSD: Ventricular septal defect.

Data taken from [69,70].

Table 4. Chance of live birth in women with cyanotic heart disease.

Factor	Chance of live birth (%)
Maternal SaO2 (%)
>90	92
85–90	45
<85	12
Maternal Hb (g/dl)
<16	71
17–19	45
>20	8

Hb: Hemoglobin.

Data from[74].

Activity Evaluation: Where 1 is strongly disagree and 5 is strongly agree

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Presbitero P, Somerville J, Stone S, Aruta E, Spiegelhalter D, Rabajoli F. Pregnancy in cyanotic heart disease. Outcome of mother and fetus. Circulation89, 2673–2676 (1994).

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