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Brachfeld D, Weiniger CF, Elchalal U, Eventov-Friedman S, Nir A. Effect of multiple births on cardiac status of women with congenital heart disease: A matched case-controlled study. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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2
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O'Kelly AC, Scott N, DeFaria Yeh D. Delivering Coordinated Cardio-Obstetric Care from Preconception through Postpartum. Cardiol Clin 2021; 39:163-173. [PMID: 33222811 DOI: 10.1016/j.ccl.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Coordinated preconception through postpartum cardio-obstetrics care is necessary to optimize both maternal and fetal health. Maternal mortality in the United States is increasing, largely driven by increasing cardiovascular (CV) disease burden during pregnancy and needs to be addressed emergently. Both for women with congenital and acquired heart disease, CV complications during pregnancy are associated with increased future risk of CV disease. Comprehensive cardio-obstetrics care is a powerful way of ensuring that women's CV risks before and during pregnancy are appropriately identified and treated and that they remain engaged in CV care long term to prevent future CV complications.
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Affiliation(s)
- Anna C O'Kelly
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Yawkey 5700, 55 Fruit Street, Boston, MA 02114, USA
| | - Nandita Scott
- Division of Cardiology, Cardiovascular Disease and Pregnancy Program, Massachusetts General Hospital and Harvard Medical School, Yawkey 5700, 55 Fruit Street, Boston, MA 02114, USA
| | - Doreen DeFaria Yeh
- Division of Cardiology, Cardiovascular Disease and Pregnancy Program, Massachusetts General Hospital and Harvard Medical School, Yawkey 5700, 55 Fruit Street, Boston, MA 02114, USA.
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Siu SC, Lee DS, Rashid M, Fang J, Austin PC, Silversides CK. Long-Term Cardiovascular Outcomes After Pregnancy in Women With Heart Disease. J Am Heart Assoc 2021; 10:e020584. [PMID: 34032120 PMCID: PMC8483519 DOI: 10.1161/jaha.120.020584] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022]
Abstract
Background Women with heart disease are at risk for pregnancy complications, but their long-term cardiovascular outcomes after pregnancy are not known. Methods and Results We examined long-term cardiovascular outcomes after pregnancy in 1014 consecutive women with heart disease and a matched group of 2028 women without heart disease. The primary outcome was a composite of mortality, heart failure, atrial fibrillation, stroke, myocardial infarction, or arrhythmia. Secondary outcomes included cardiac procedures and new hypertension or diabetes mellitus. We compared the rates of these outcomes between women with and without heart disease and adjusted for maternal and pregnancy characteristics. We also determined if pregnancy risk prediction tools (CARPREG [Canadian Cardiac Disease in Pregnancy] and World Health Organization) could stratify long-term risks. At 20-year follow-up, a primary outcome occurred in 33.1% of women with heart disease, compared with 2.1% of women without heart disease. Thirty-one percent of women with heart disease required a cardiac procedure. The primary outcome (adjusted hazard ratio, 19.6; 95% CI, 13.8-29.0; P<0.0001) and new hypertension or diabetes mellitus (adjusted hazard ratio, 1.6; 95% CI, 1.4-2.0; P<0.0001) were more frequent in women with heart disease compared with those without. Pregnancy risk prediction tools further stratified the late cardiovascular risks in women with heart disease, a primary outcome occurring in up to 54% of women in the highest pregnancy risk category. Conclusions Following pregnancy, women with heart disease are at high risk for adverse long-term cardiovascular outcomes. Current pregnancy risk prediction tools can identify women at highest risk for long-term cardiovascular events.
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Affiliation(s)
- Samuel C. Siu
- Division of CardiologyUniversity of Toronto Pregnancy and Heart Disease ProgramTorontoCanada
- Maternal Cardiology ProgramDivision of CardiologyDepartment of MedicineSchulich School of Medicine and DentistryLondonOntarioCanada
- ICESTorontoOntarioCanada
- Division of CardiologyDepartment of MedicineMount Sinai Hospital and University Health NetworkUniversity of TorontoCanada
| | - Douglas S. Lee
- ICESTorontoOntarioCanada
- Division of CardiologyDepartment of MedicineMount Sinai Hospital and University Health NetworkUniversity of TorontoCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
| | | | | | - Peter C. Austin
- ICESTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoCanada
| | - Candice K. Silversides
- Division of CardiologyUniversity of Toronto Pregnancy and Heart Disease ProgramTorontoCanada
- Division of CardiologyDepartment of MedicineMount Sinai Hospital and University Health NetworkUniversity of TorontoCanada
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4
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Fürniss HE, Stiller B. Arrhythmic risk during pregnancy in patients with congenital heart disease. Herzschrittmacherther Elektrophysiol 2021; 32:174-179. [PMID: 33796929 DOI: 10.1007/s00399-021-00754-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
Arrhythmias play a significant role in the morbidity and mortality of patients with adult congenital heart disease (CHD). Pregnancy-associated physiological changes in hormonal status, hemodynamics, and myocardial structure further enhance arrhythmic risk in CHD patients, leading to increased adverse maternal and foetal events and making arrhythmias one of the most common complications during pregnancy. Nearly all CHD patients are affected by asymptomatic rhythm disturbances during the ante-, peri-, or post-partum periods, and almost one tenth of patients develop sustained, symptomatic arrhythmias requiring treatment. The majority of arrhythmias originate from the atrium, mostly in the form of supraventricular tachycardia or atrial fibrillation. Patients with CHD often tolerate these even more poorly during pregnancy than before pregnancy. Sustained ventricular tachycardia or ventricular fibrillation are rare, but potentially life-threatening for mother and foetus. Risk stratification models developed specifically for arrhythmias during pregnancy in CHD patients are lacking, but direct or indirect signs of heart failure, previous history of arrhythmia, and complex CHD may be associated with higher arrhythmic risk in these patients. Rigorous individual assessment before, and careful monitoring during pregnancy in a multidisciplinary team is crucial to ensure the best possible pregnancy outcome for patients with CHD.
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Affiliation(s)
- Hannah E Fürniss
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
| | - Brigitte Stiller
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
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5
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Siegmund AS, Pieper PG, Bouma BJ, Rosenberg FM, Groen H, Bilardo CM, van Veldhuisen DJ, Dickinson MG. Early N-terminal pro-B-type natriuretic peptide is associated with cardiac complications and function during pregnancy in congenital heart disease. Neth Heart J 2021; 29:262-272. [PMID: 33534113 PMCID: PMC8062639 DOI: 10.1007/s12471-021-01540-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 20 weeks’ gestation predict adverse cardiovascular (CV) complications during pregnancy in women with congenital heart disease (CHD). To improve early risk assessment in these women, we investigated the predictive value of first-trimester NT-proBNP for CV complications and its association with ventricular function during pregnancy. Methods Pregnant women with CHD, previously enrolled in a prospective national study or evaluated by an identical protocol, were included. Clinical data, echocardiographic evaluation and NT-proBNP measurements were obtained at 12, 20 and 32 weeks’ gestation. Elevated NT-proBNP was defined as > 235 pg/ml (95th percentile reference value of healthy pregnant women in the literature). Results We examined 126 females (mean age 29 years). Elevated NT-proBNP at 12 weeks was associated with CV complications (n = 7, 5.6%, odds ratio 10.9, p = 0.004). Arrhythmias were the most common complication (71%). The negative predictive value of low NT-proBNP to exclude CV complications was 97.2%. In women with CV complications, NT-proBNP levels remained high throughout pregnancy, while a decrease was seen in women without CV complications (p < 0.001 for interaction between group and time). At 12 weeks, higher NT-proBNP levels were associated with impaired subpulmonary ventricular function (p < 0.001) and also with a decline in subpulmonary ventricular function later in pregnancy (p = 0.012). Conclusions In this study, first-trimester NT-proBNP levels were associated with adverse CV complications and a decline in subpulmonary ventricular function later in pregnancy in women with CHD. Early NT-proBNP evaluation is useful for tailored care in pregnant women with CHD.
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Affiliation(s)
- A S Siegmund
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - P G Pieper
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B J Bouma
- Department of Cardiology, Heart Centre, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - F M Rosenberg
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H Groen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M G Dickinson
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Kloster S, Andersen AMN, Johnsen SP, Nielsen DG, Ersbøll AK, Tolstrup JS. Advanced maternal age and risk of adverse perinatal outcome among women with congenital heart disease: A nationwide register-based cohort study. Paediatr Perinat Epidemiol 2020; 34:637-644. [PMID: 32207177 DOI: 10.1111/ppe.12672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/24/2020] [Accepted: 02/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women with maternal congenital heart disease have a higher risk of preterm birth (PTB) and giving birth to a small for gestational age (SGA) infant. Advanced maternal age (≥35 years) likewise increases the risk of PTB and SGA, probably explained by poorer cardiovascular status. It is likely that advanced maternal age is particularly detrimental in women with congenital heart disease. OBJECTIVES We aimed to determine whether the pattern of higher risk of PTB and SGA with higher maternal age varied among women with and without congenital heart disease. We hypothesised that the effect of age is higher among women with congenital heart disease. METHODS We did a cohort study using Danish nationwide registers. Births from 1997 to 2014 were included. Cox regressions were used to estimate hazard ratios (HRs) for PTB and SGA. Universal and congenital heart disease-specific references were used for comparison. RESULTS We included 932 772 births among 548 314 women. HRs of PTB and SGA were 1.55 (95% confidence interval [CI] 1.37, 1.77) and 1.43 (95% CI 1.29, 1.58) in women with congenital heart disease as compared to women without. For both PTB and SGA, HRs were higher for women ≥35 years as compared to women aged 25-29 years. HRs of PTB and SGA were higher among women with congenital heart disease within all strata of maternal age as compared to women without (eg 3.71, 95% CI 1.80, 7.63 vs 1.63, 95% CI 1.56, 1.70) for SGA for women aged 40-44 years). The pattern of higher risk of PTB and SGA with higher maternal age was, however, similar among women with and without congenital heart disease. CONCLUSIONS Women with congenital heart disease had a higher risk of PTB and giving birth to an SGA infant at all maternal ages. These two risk factors did not, however, seem to potentiate each other.
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Affiliation(s)
- Stine Kloster
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dorte Guldbrand Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Annette Kjaer Ersbøll
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Janne S Tolstrup
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Ramlakhan KP, Ahmed I, Johnson MR, Roos-Hesselink JW. Congenital heart disease and family planning: Preconception care, reproduction, contraception and maternal health. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2020. [DOI: 10.1016/j.ijcchd.2020.100049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Ramage K, Grabowska K, Silversides C, Quan H, Metcalfe A. Maternal, pregnancy, and neonatal outcomes for women with Turner syndrome. Birth Defects Res 2020; 112:1067-1073. [PMID: 32524771 DOI: 10.1002/bdr2.1739] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/17/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Turner syndrome (TS) occurs in approximately 1 in 2500 live female births and is caused by the partial or complete loss of one of the X chromosomes, resulting in abnormalities such as ovarian failure and infertility. However, pregnancy in women with TS may still occur via spontaneous pregnancy or through oocyte donation. Limited data exists on pregnancy in women with TS that could aid in clinical care. METHODS We conducted a population-based cross-sectional study using data from the Discharge Abstract Database (2004-2015), which contains all labor and delivery hospitalizations across Canada (excluding Quebec) where women delivered a live or stillborn infant. The odds of adverse maternal and neonatal outcomes for women with and without TS were calculated using backwards multivariable logistic regression with generalized estimating equations, adjusting for the Obstetric Comorbidity Index, mode of delivery, and year. RESULTS Overall, 2,682,284 women delivered a live or stillborn infant during the study period and 44 birth events occurred for women with TS. No severe maternal morbidity or adverse cardiovascular events occurred for women with TS at their labor and delivery hospitalization. However, infants born to women with TS were 3.6 times more likely (95% CI: 1.7-7.8) to experience neonatal morbidity than those born to women without TS. These infants also were more likely to have had a preterm birth (aOR: 2.9, 95% CI: 1.6-5.4) and to be small-for-gestational-age (aOR: 4.5, 95% CI: 2.4-8.4). CONCLUSION This study adds further understanding of the likelihood of adverse outcomes for pregnant women with TS.
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Affiliation(s)
- Kaylee Ramage
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kirsten Grabowska
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Obstetrics & Gynaecology, University of Calgary, Calgary, Alberta, Canada
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9
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Does pregnancy impact subsequent health outcomes in the maternal Fontan circulation? Int J Cardiol 2020; 301:67-73. [DOI: 10.1016/j.ijcard.2019.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/16/2019] [Accepted: 08/14/2019] [Indexed: 11/23/2022]
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10
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Hayward RM, Foster E, Tseng ZH. Maternal and Fetal Outcomes of Admission for Delivery in Women With Congenital Heart Disease. JAMA Cardiol 2019; 2:664-671. [PMID: 28403428 DOI: 10.1001/jamacardio.2017.0283] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Women with congenital heart disease (CHD) may be at increased risk for adverse events during pregnancy and delivery. Objective To compare delivery outcomes between women with and without CHD. Design, Setting, and Participants This retrospective study of inpatient delivery admissions in the Healthcare Cost and Utilization Project's California State Inpatient Database compared maternal and fetal outcomes between women with and without CHD by using multivariate logistic regression. Female patients with codes for delivery from the International Classification of Diseases, Ninth Revision, from January 1, 2005, through December 31, 2011, were included. The association of CHD with readmission was assessed to 7 years after delivery. Cardiovascular morbidity and mortality were hypothesized to be higher among women with CHD. Data were analyzed from April 4, 2014, through January 23, 2017. Exposures Noncomplex and complex CHD. Main Outcomes and Measures Maternal outcomes included in-hospital arrhythmias, eclampsia or preeclampsia, congestive heart failure (CHF), length of stay, preterm labor, anemia complicating pregnancy, placental abnormalities, infection during labor, maternal readmission at 1 year, and in-hospital mortality. Fetal outcomes included growth restriction, distress, and death. Results Among 3 642 041 identified delivery admissions, 3189 women had noncomplex CHD (mean [SD] age, 28.6 [7.6] years) and 262 had complex CHD (mean [SD] age, 26.5 [6.8] years). Women with CHD were more likely to undergo cesarean delivery (1357 [39.3%] vs 1 164 509 women without CHD [32.0%]; P < .001). Incident CHF, atrial arrhythmias, ventricular arrhythmias, and maternal mortality were uncommon during hospitalization, with each occurring in fewer than 10 women with noncomplex or complex CHD (<0.5% each). After multivariate adjustment, noncomplex CHD (odds ratio [OR], 9.7; 95% CI, 4.7-20.0) and complex CHD (OR, 56.6; 95% CI, 17.6-182.5) were associated with greater odds of incident CHF. Similar odds were found for atrial arrhythmias in noncomplex (OR, 8.2; 95% CI, 3.0-22.7) and complex (OR, 31.8; 95% CI, 4.3-236.3) CHD, for fetal growth restriction in noncomplex (OR, 1.6; 95% CI, 1.3-2.0) and complex (OR, 3.5; 95% CI, 2.1-6.1) CHD, and for hospital readmission in both CHD groups combined (OR, 3.6; 95% CI, 3.3-4.0). Complex CHD was associated with greater adjusted odds of serious ventricular arrhythmias (OR, 31.8; 95% CI, 4.3-236.3) and maternal in-hospital mortality (OR, 79.1; 95% CI, 23.9-261.8). Conclusions and Relevance In this study of hospital admissions for delivery in California, CHD was associated with incident CHF, atrial arrhythmias, and fetal growth restriction and complex CHD was associated with ventricular arrhythmias and maternal in-hospital mortality, although these outcomes were rare, even in women with complex CHD. These findings may guide monitoring decisions and risk assessment for pregnant women with CHD at the time of delivery.
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Affiliation(s)
- Robert M Hayward
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco2now with Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Memorial Medical Center, Worcester
| | - Elyse Foster
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
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11
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Li Q, Dimopoulos K, Liu T, Xu Z, Liu Q, Li Y, Zhang J, Gu H. Peripartum outcomes in a large population of women with pulmonary arterial hypertension associated with congenital heart disease. Eur J Prev Cardiol 2019; 26:1067-1076. [PMID: 30971116 DOI: 10.1177/2047487318821246] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aims Pulmonary arterial hypertension is a severe complication in patients with congenital heart disease and poses a significant risk to women wishing to become pregnant. This study describes the clinical presentation, maternal outcomes and risk factors for the peripartum period in women with pulmonary arterial hypertension related to congenital heart disease (PAH-CHD). Methods All pregnant women with PAH-CHD who were admitted for delivery in a tertiary center between February 2011–September 2016 were included. Logistic regression analysis was used to identify predictors of the combined endpoint of maternal death, severe heart failure requiring treatment, or pulmonary hypertensive crisis. Results Ninety-three women (94 pregnancies) were included. Average age was 27.5 ± 4.4 years. Thirty (31.9%) patients had Eisenmenger syndrome, 51 (54.3%) had pulmonary arterial hypertension associated with systemic-to-pulmonary shunts, and 13 (13.8%) had pulmonary arterial hypertension with corrected congenital heart disease. Twenty-three (24.5%) women required admission for delivery within two days from presentation. Elective Cesarean section was performed in 95.7% of women, with intravertebral anesthesia in 93.6%. Fifty-one (54.2%) patients received pulmonary arterial hypertension therapies during pregnancy. Six (6.4%) women died, 33 (35.1%) developed heart failure and 10 (10.6%) had a pulmonary hypertensive crisis. Patients who met the combined endpoint ( n = 34, 36.2%) were more likely to have Eisenmenger syndrome or repaired defects ( p < 0.001). Other risk factors in the multivariate model included lower arterial blood oxygen saturation, higher brain natriuretic peptide, and pericardial effusion on echocardiography. Conclusion Maternal mortality and morbidity remain high in PAH-CHD patients, who should be counseled on the risks of pregnancy and managed in a tertiary multidisciplinary environment to improve prognosis.
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Affiliation(s)
- Qiangqiang Li
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Konstantinos Dimopoulos
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital and Imperial College, UK
| | - Tianyang Liu
- Hospital Manager Office, Beijing Anzhen Hospital, China
| | - Zhuoyuan Xu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Qian Liu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Yanna Li
- Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Jun Zhang
- Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University, China
| | - Hong Gu
- Department of Pediatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, China
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12
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Smith K, Gros B. Pregnancy-related acute aortic dissection in Marfan syndrome: A review of the literature. CONGENIT HEART DIS 2017; 12:251-260. [PMID: 28371362 DOI: 10.1111/chd.12465] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 11/25/2022]
Abstract
A well-established association exists between acute aortic dissection and pregnancy, particularly in women with Marfan syndrome. However, there is debate regarding appropriate management guidelines. In particular, there are differing opinions regarding when prophylactic aortic root repair should be recommended as well as the efficacy of beta blockers in this clinical scenario. The current study evaluated 10 years of published literature (2005-2015) in the PubMed/Medline database. Fifty articles, describing 72 cases of women who presented with aortic dissection in the antepartum or postpartum period were identified. Comparisons on demographic variables and clinical outcomes between cases of women with Marfan syndrome (n = 36) and without Marfan syndrome (n = 36) were conducted. There were no significant differences in demographics (age, gravidity, parity) between the Marfan and non-Marfan cases. Marfan patients presented with antepartum dissections significantly earlier in pregnancy than those without Marfan syndrome (P = .002). However, there were no significant difference between the 2 groups in maternal mortality, fetal mortality, or obstetric outcomes (mode of delivery and gestational age at delivery). Eight cases described events in Marfan women with an aortic root diameter ≤40 mm. Six events occurred in Marfan women who were managed with beta blockers. Current guidelines rely on aortic root diameter for stratification of Marfan women into risk categories, but we identified several cases that would be missed by these guidelines. Specifically, the existing literature suggest that women with Marfan syndrome should take precautions throughout pregnancy, rather than the third trimester.
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Affiliation(s)
| | - Bernard Gros
- University of Central Florida College of Medicine
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13
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Kampman MAM, Siegmund AS, Bilardo CM, van Veldhuisen DJ, Balci A, Oudijk MA, Groen H, Mulder BJM, Roos-Hesselink JW, Sieswerda G, de Laat MWM, Sollie-Szarynska KM, Pieper PG. Uteroplacental Doppler flow and pregnancy outcome in women with tetralogy of Fallot. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:231-239. [PMID: 27071979 DOI: 10.1002/uog.15938] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Pregnancy in women with surgically corrected tetralogy of Fallot (ToF) is associated with cardiac, obstetric and neonatal complications. We compared uteroplacental Doppler flow (UDF) measurements and pregnancy outcome in women with ToF and in healthy women and aimed to assess whether a relationship exists between cardiac function and UDF in women with ToF. METHODS We evaluated prospectively pregnant women with ToF and healthy pregnant women from the ZAHARA studies. Clinical evaluation, standardized echocardiography and UDF measurements were performed at 20 and 32 weeks' gestation. RESULTS We included 62 women with ToF and 69 healthy controls. Cardiac complications, mostly arrhythmia, occurred in 8.1% of women with ToF. There was a higher incidence of small-for-gestational age (21.0% vs 4.4%, P = 0.004) and low birth weight (16.1% vs 2.9%, P = 0.009) in the group of women with ToF than in healthy controls. In women with ToF, early diastolic notching of uterine artery waveform at 20 and 32 weeks occurred more frequently (9.8% vs 1.5%, P = 0.034 and 7.0% vs 0%, P = 0.025, respectively) and the umbilical artery pulsatility index at 32 weeks was higher (1.02 ± 0.20 vs 0.94 ± 0.17, P = 0.015) than in healthy controls. Right ventricular function parameters prepregnancy and at 20 weeks' gestation were significantly associated with abnormal UDF. UDF parameters were associated with adverse neonatal outcome. CONCLUSION The majority of women with surgically corrected ToF tolerate pregnancy well. However, UDF indices are more frequently abnormal in these women, suggesting impaired placentation. The association of impaired right ventricular function parameters with abnormal UDF suggests that cardiac dysfunction contributes to defective placentation or placental perfusion mismatch and may explain the increased incidence of obstetric and neonatal complications. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M A M Kampman
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
| | - A S Siegmund
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Balci
- Department of Cardiology, Isala, Zwolle, The Netherlands
| | - M A Oudijk
- Department of Obstetrics, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - H Groen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
| | - G Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M W M de Laat
- Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - K M Sollie-Szarynska
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P G Pieper
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Kampman MAM, Valente MAE, van Melle JP, Balci A, Roos-Hesselink JW, Mulder BJM, van Dijk APJ, Oudijk MA, Jongbloed MRM, van Veldhuisen DJ, Pieper PG. Cardiac adaption during pregnancy in women with congenital heart disease and healthy women. Heart 2016; 102:1302-8. [DOI: 10.1136/heartjnl-2015-308946] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/09/2016] [Indexed: 11/03/2022] Open
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Hebson C, Saraf A, Book WM. Risk Assessment and Management of the Mother with Cardiovascular Disease. Clin Perinatol 2016; 43:1-22. [PMID: 26876118 DOI: 10.1016/j.clp.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic medical conditions account for most nonobstetrical pregnancy-related maternal complications. Preconception counseling of women with cardiovascular disease can be aided by an understanding of cardiovascular physiology in pregnancy and risk scores to guide management.
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Affiliation(s)
- Camden Hebson
- Department of Medicine, The Sibley Heart Center, Emory University School of Medicine, 1365 Clifton Road Northeast, Clinic A, 2nd Floor, Cardiology, Atlanta, GA 30322, USA; Department of Pediatrics, The Sibley Heart Center, Emory University School of Medicine, 1365 Clifton Road Northeast, Clinic A, 2nd Floor, Cardiology, Atlanta, GA 30322, USA
| | - Anita Saraf
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, 1365 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Wendy M Book
- Division of Cardiology, Department of Medicine, Emory Adult Congenital Heart Center, Emory University School of Medicine, 1365 Clifton Road Northeast, Clinic A, 2nd Floor, Cardiology, Atlanta, GA 30322, USA.
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Greutmann M, Pieper PG. Pregnancy in women with congenital heart disease. Eur Heart J 2015; 36:2491-9. [DOI: 10.1093/eurheartj/ehv288] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 06/05/2015] [Indexed: 11/15/2022] Open
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