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Review

Pregnancy in women with congenital heart disease: a focus on management and preventing the risk of complications

ORCID Icon, , , & ORCID Icon
Pages 587-599 | Received 14 Apr 2023, Accepted 14 Jul 2023, Published online: 20 Jul 2023

References

  • Curtis SL, Marsden-Williams J, Sullivan C, et al. Current trends in the management of heart disease in pregnancy. Int J Cardiol. 2009;133(1):62–69. doi: 10.1016/j.ijcard.2007.11.084
  • Siu SC, Sermer M, Colman JM, et al. Cardiac Disease in Pregnancy (CARPREG) investigators. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104(5):515–521. doi: 10.1161/hc3001.093437
  • American College of Cardiology Cardiovascular Disease in Women Committee and the Cardio-Obstetrics Work Group, Lindley KJ, Bairey Merz CN, et al. Management of women with congenital or inherited cardiovascular disease from pre-conception through pregnancy and postpartum: JACC focus seminar 2/5. J Am Coll Cardiol. 2021;77(14):1778–1798.
  • Bruneau BG. The developmental genetics of congenital heart disease. Nature. 2008;451(7181):943–948. doi: 10.1038/nature06801
  • Goland S, Elkayam U. Pregnancy and Marfan syndrome. Ann Cardiothorac Surg. 2017;6(6):642–653. doi: 10.21037/acs.2017.10.07
  • Roos-Hesselink J, Baris L, Johnson M, et al. Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry of Pregnancy and Cardiac disease (ROPAC). Eur Heart J. 2019;40(47):3848–3855. doi: 10.1093/eurheartj/ehz136
  • Van Hagen IM, Roos-Hesselink JW. Pregnancy in congenital heart disease: risk prediction and counselling. Heart. 2020;106(23):1853–1861. doi: 10.1136/heartjnl-2019-314702
  • El-Hamamsy I, Zaki M, Stevens LM, et al. Rate of progression and functional significance of aortic root calcification after homograft vs freestyle aortic root replacement. Circulation. 2009;120(11_suppl_1):S269–75. doi: 10.1161/CIRCULATIONAHA.108.843748
  • Musci M, Weng Y, Hubler M, et al. Homograft aortic root replacement in native or prosthetic active infective endocarditis: twenty-year single-center experience. J Thorac Cardiovasc Surg. 2010;139(3):665–673. doi: 10.1016/j.jtcvs.2009.07.026
  • Elkayam U, Bitar F. Valvular heart disease and pregnancy: part II: prosthetic valves. J Am Coll Cardiol. 2005;46(3):403–410. doi: 10.1016/j.jacc.2005.02.087
  • Ginsberg JS, Chan WS, Bates SM, et al. Anticoagulation of pregnant women with mechanical heart valves. Arch Intern Med. 2003;163(6):694–698. doi: 10.1001/archinte.163.6.694
  • McLintock C. Anticoagulant therapy in pregnant women with mechanical prosthetic heart valves: no easy option. Thromb Res. 2011;127(3):S56–S60. doi: 10.1016/S0049-3848(11)70016-0
  • Vahanian A, Beyersdorf F, et al. ESC/EACTS Scientific Document Group, 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol (Engl Ed). 2022;75(6):524.
  • Otto CM, Nishimura RA, bonow ro, et al. 2020 acc/aha guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2021;143(5):e72–e227. doi: 10.1161/CIR.0000000000000923
  • Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy: the task force for the management of cardiovascular diseases during pregnancy of the European society of cardiology (ESC). Eur Heart J. 2018;39(34):3165–3241. doi: 10.1093/eurheartj/ehy340
  • Pijuan-Domenech A, Galian L, Goya M, et al. Cardiac complications during pregnancy are better predicted with the modified who risk score. Int J Cardiol. 2015;195:149–154. doi: 10.1016/j.ijcard.2015.05.076
  • Silversides CK, Grewal J, Mason J, et al. Pregnancy outcomes in women with heart disease: the CARPREG II study. J Am Coll Cardiol. 2018;71(21):2419–2430. doi: 10.1016/j.jacc.2018.02.076
  • Drenthen W, Boersma E, Balci A, et al. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J. 2010;31(17):2124–2132. doi: 10.1093/eurheartj/ehq200
  • Lu CW, Shih JC, Chen SY, et al. Comparison of 3 Risk estimation methods for predicting cardiac outcomes in pregnant women with congenital heart disease. Circ J. 2015;79(7):1609–1617. doi: 10.1253/circj.CJ-14-1368
  • Meah VL, Cockcroft JR, Backx K, et al. Cardiac output and related haemodynamics during pregnancy: a series of meta-analyses. Heart. 2016;102(7):518–526. doi: 10.1136/heartjnl-2015-308476
  • Boardman H, Ormerod O, Leeson P. Haemodynamic changes in pregnancy: what can we learn from combined datasets? Heart. 2016;102(7):490–491. doi: 10.1136/heartjnl-2015-309166
  • Ruys TP, Cornette J, Roos-Hesselink JW. Pregnancy and delivery in cardiac disease. J Cardiol. 2013;61(2):107–112. doi: 10.1016/j.jjcc.2012.11.001
  • Kim MY, Buyon JP, Guerra MM, et al. Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies: results of the PROMISSE study. Am J Obstet Gynecol. 2016;214(1):.e108.1–.e108.14. doi: 10.1016/j.ajog.2015.09.066
  • Lewey J, Andrade L, Levine LD. Valvular heart disease in pregnancy. Cardiol Clin. 2021;39(1):151–161. doi: 10.1016/j.ccl.2020.09.010
  • Anthony J, Osman A, Sani MU. Valvular heart disease in pregnancy. Cardiovasc J Afr. 2016;27(2):111–118. doi: 10.5830/CVJA-2016-052
  • Shapero KS, Nauriyal V, Megli C, et al. Management of infective endocarditis in pregnancy by a multidisciplinary team: a case series. Ther Adv Infect Dis. 2022;9:20499361221080644. doi: 10.1177/20499361221080644
  • Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet. 1999;353(9160):1258–1265. doi: 10.1016/S0140-6736(98)10265-9
  • Kujovich JL. Hormones and pregnancy: thromboembolic risks for women. Br J Haematol. 2004;126(4):443–454. doi: 10.1111/j.1365-2141.2004.05041.x
  • Heit JA, Kobbervig CE, James AH, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005;143(10):697–06. doi: 10.7326/0003-4819-143-10-200511150-00006
  • Curry RA, Gelson E, Swan L, et al. Marfan syndrome and pregnancy: Maternal and neonatal outcomes. BJOG: Int J Obstet Gy. 2014;121(5):610–617. doi: 10.1111/1471-0528.12515
  • Carlson M, Airhart N, Lopez L, et al. Moderate aortic enlargement and bicuspid aortic valve are associated with aortic dissection in turner syndrome: Report of the international Turner syndrome aortic dissection registry. Circulation. 2012;126(18):2220–2226. doi: 10.1161/CIRCULATIONAHA.111.088633
  • Nienaber CA, Fattori R, Mehta RH, et al. Gender related differences in acute aortic dissection. Circulation. 2004;109(24):3014–3021. doi: 10.1161/01.CIR.0000130644.78677.2C
  • Pieper PG. Use of medication for cardiovascular disease during pregnancy. Nat Rev Cardiol. 2015;12(12):718–729. doi: 10.1038/nrcardio.2015.172
  • Roos-Hesselink JW, Cornette J, Sliwa K, et al. Contraception and cardiovascular disease. Eur Heart J. 2015;36(27):1728–1734. doi: 10.1093/eurheartj/ehv141
  • Lidegaard O, Lokkegaard E, Svendsen AL, et al. Hormonal contraception and risk of venous thromboembolism: National follow-up study. BMJ. 2009;339(aug13 2):b2890. doi: 10.1136/bmj.b2890
  • Martinez-Portilla RJ, Poon LC, Benitez-Quintanilla L, et al. Incidence of pre-eclampsia and other perinatal complications among pregnant women with congenital heart disease: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2021 Oct;58(4):519–528.
  • Lammers AE, Diller GP, Lober R, et al. Maternal and neonatal complications in women with congenital heart disease: a nationwide analysis. Eur Heart J. 2021;42(41):4252–4260. doi: 10.1093/eurheartj/ehab571
  • Sliwa K, Azibani F, Johnson MR, et al. Effectiveness of implanted cardiac rhythm recorders with electrocardiographic monitoring for detecting arrhythmias in pregnant women with symptomatic arrhythmia and/or structural heart disease: a randomized clinical trial. JAMA Cardiol. 2020;5(4):458–463. doi: 10.1001/jamacardio.2019.5963
  • Kirby A, Curtis E, Hlohovsky S, et al. Pregnancy outcomes and risk evaluation in a contemporary adult congenital heart disease cohort. Heart Lung Circ. 2021;30(9):1364–1372. doi: 10.1016/j.hlc.2021.03.005
  • Yap SC, Drenthen W, Meijboom FJ, et al. Comparison of pregnancy outcomes in women with repaired versus unrepaired atrial septal defect. BJOG. 2009;116(12):1593–1601. doi: 10.1111/j.1471-0528.2009.02301.x
  • Mendelson MA. Pregnancy in women with left-to-right cardiac shunts: Any risk? Int J Cardiol Congenit Heart Dis. 2021;5:100209. doi: 10.1016/j.ijcchd.2021.100209
  • Silversides CK, Colman JM, Sermer M, et al. Early and intermediate-term outcomes of pregnancy with congenital aortic stenosis. Am J Cardiol. 2003;91(11):1386–1389. doi: 10.1016/S0002-9149(03)00340-0
  • Elkayam U, Bitar F. Valvular heart disease and pregnancy part I: native valves. J Am Coll Cardiol. 2005;46(2):223–230. doi: 10.1016/j.jacc.2005.02.085
  • Samiei N, Amirsardari M, Rezaei Y, et al. Echocardiographic evaluation of hemodynamic changes in left-sided heart valves in pregnant women with valvular heart disease. Am J Cardiol. 2016;118(7):1046–1052. doi: 10.1016/j.amjcard.2016.07.005
  • Zentner D, Kotevski A, King I, et al. Fertility and pregnancy in the Fontan population. Int J Cardiol. 2016;208:97–01. doi: 10.1016/j.ijcard.2016.01.180
  • Canobbio MM, Mair DD, van der Velde M, et al. Pregnancy outcomes after the Fontan repair. J Am Coll Cardiol. 1996;28(3):763–767. doi: 10.1016/0735-1097(96)00234-3
  • Lao TT, Sermer M, Colman JM. Pregnancy after the Fontan procedure for tricuspid atresia. A case report. J Reprod Med. 1996;41(4):287–290.
  • Gnanaraj JP, Anne Princy S. Surendran Anju, et al on behalf of the M-PAC investigators. Pregnancy outcomes in women with heart disease: the Madras Medical College Pregnancy and Cardiac (M-PAC) Registry from India. Eur Heart J. 2023;1–12.
  • Jolien WR-H, Van der Zande JA, Johnson MR. Pregnancy outcomes in women with heart disease: how to improve? Eur Heart J. 2023;1–3.
  • Pierpont ME, Basson CT, Benson DW Jr, et al. Genetic basis for congenital heart defects: Current knowledge. Circulation. 2007;115(23):3015–3038. doi: 10.1161/CIRCULATIONAHA.106.183056
  • Sayama S, Takeda N, Fujii T, et al. Peripartum type B aortic dissection in patients with Marfan syndrome who underwent aortic root replacement: a case series study. BJOG. 2018 Mar;125(4):487–493.
  • Song S, Lu L, Li L, et al. Antepartum acute Stanford type a aortic dissection: a case report and literature review. J Cardiothorac Surg. 2022;17(1):73. doi: 10.1186/s13019-022-01817-7
  • Meccanici F, Gökalp AL, Thijssen CGE, et al. Male-female differences in acute thoracic aortic dissection: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2022;34(4):616–627. doi: 10.1093/icvts/ivab270
  • Baris L, Ladouceur M, Johnson MR, et al. Pregnancy in Tetralogy of Fallot data from the ESC EORP ROPAC registry. Int J Cardiol Congenit Heart Dis. 2021;2:100059. doi: 10.1016/j.ijcchd.2020.100059
  • Wang K, Xin J, Wang X, et al. Pregnancy outcomes among 31 patients with tetralogy of Fallot, a retrospective study. Bmc Pregnancy Childbirth. 2019;19(1):486. doi: 10.1186/s12884-019-2630-y
  • Balci A, Drenthen W, Mulder BJ, et al. Pregnancy in women with corrected tetralogy of Fallot: occurrence and predictors of adverse events. Am Heart J. 2011;161(2):307–313. doi: 10.1016/j.ahj.2010.10.027
  • Fahed AC, Gelb BD, Seidman JG, et al. Genetics of congenital heart disease: the glass half empty. Circ Res. 2013;112(4):707–720. doi: 10.1161/CIRCRESAHA.112.300853
  • Tutarel O, Ramlakhan KP, Baris L, et al. ROPAC (Registry of Pregnancy and Cardiac Disease) Investigators Group. Pregnancy outcomes in women after arterial switch operation for transposition of the great arteries: results from ROPAC (Registry of Pregnancy and Cardiac Disease) of the European society of cardiology EURObservational research programme. J Am Heart Assoc. 2021 5;10(1):e018176. doi: 10.1161/JAHA.120.018176
  • ROPAC Investigators Group, Tutarel O, Baris L, et al. Pregnancy outcomes in women with a systemic right ventricle and transposition of the great arteries results from the ESC-EORP Registry of Pregnancy and Cardiac disease (ROPAC). Heart. 2022;108(2):117–123.
  • Sliwa K, van Hagen IM, Budts W, et al. ROPAC investigators. Society of cardiology pulmonary hypertension and pregnancy outcomes: data from the Registry of Pregnancy and Cardiac Disease (ROPAC) of the European. Eur J Heart Fail. 2016;18(9):1119–1128. doi: 10.1002/ejhf.594
  • Zhang Q, Zhu F, Shi G, et al. Maternal outcomes among pregnant women with congenital heart disease-associated pulmonary hypertension. Circulation. 2023;147(7):549–561. doi: 10.1161/CIRCULATIONAHA.122.057987
  • Presbitero P, Somerville J, Stone S, et al. Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. Circulation. 1994;89(6):2673–2676. doi: 10.1161/01.CIR.89.6.2673
  • Economy KE, Valente AM. Mechanical heart valves in pregnancy: a sticky business. Circulation. 2015;132(2):79–81. doi: 10.1161/CIRCULATIONAHA.115.017349
  • Schaefer C, Hannemann D, Meister R, et al. Vitamin K antagonists and pregnancy outcome. A multi-centre prospective study. Thromb Haemost. 2006 Jun;95(6):949–957.
  • Hassounaa A, Allam H. Limited dose warfarin throughout pregnancy in patients with mechanical heart valve prosthesis: a meta-analysis. Interact Cardiovasc Thorac Surg. 2014;18(6):797–06. doi: 10.1093/icvts/ivu009
  • Xu Z, Fan J, Luo X, et al. Anticoagulation regimens during pregnancy in patients with mechanical heart valves: A systematic review and meta-analysis. Can J Cardiol. 2016;32(10):1248. e1–1248.e9. doi: 10.1016/j.cjca.2015.11.005
  • Stephenson ML, Serra AE, Neeper JM, et al. A randomized controlled trial of differing doses of postcesarean enoxaparin thromboprophylaxis in obese women. J Perinatol. 2016;36(2):95–99. doi: 10.1038/jp.2015.130
  • Shapiro NL, Kominiarek MA, Nutescu EA, et al. Dosing and monitoring of low-molecular-weight heparin in high-risk pregnancy: single-center experience. Pharmacotherapy. 2011;31(7):678–685. doi: 10.1592/phco.31.7.678
  • Ruys TPE, Roos-Hesselink JW, Pijuan-Domènech A, et al. Is a planned caesarean section in women with cardiac disease beneficial? Heart. 2015;101(7):530–536. doi: 10.1136/heartjnl-2014-306497
  • San-Frutos L, Engels V, Zapardiel I, et al. Hemodynamic changes during pregnancy and postpartum: a prospective study using thoracic electrical bioimpedance. J Matern Fetal Neonatal Med. 2011;24(11):1333–1340. doi: 10.3109/14767058.2011.556203
  • Davis Melinda B, Arendt K, Bello NA, et al. Team-based care of women with cardiovascular disease from pre-conception through pregnancy and postpartum. J Am Coll Cardiol. 2021;77(14):1763–1777. doi: 10.1016/j.jacc.2021.02.033
  • Lima F, Nie L, Yang J, et al. Postpartum cardiovascular outcomes among women with heart disease from a nationwide study. Am J Cardiol. 2019;123(12):2006–2014. doi: 10.1016/j.amjcard.2019.03.012