Many Women with Congenital Heart Disease Can Tolerate Pregnancy Safely

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Summary and Comment

Many Women with Congenital Heart Disease Can Tolerate Pregnancy Safely

Most pregnancies resulted in normal births, but cardiac complications were common among women with complex CHD.

As women with congenital heart disease (CHD) reach adulthood, they face decisions about childbearing and must weigh its risks to mother and child. In a review of 48 studies published since 1985, investigators evaluated the outcomes of approximately 2500 pregnancies in women with all types of CHD.

Miscarriages occurred in 30% to 40% of pregnant women who had pulmonary atresia with ventricular septal defects (PAVSDs), Fontan-repaired conditions (characterized by a single functional ventricle), and cyanotic heart disease, but in fewer than 20% of women with other conditions. (For reference, the general U.S. miscarriage rate is approximately 8%.) Overall, fetal and perinatal mortality was 4%; however, among the offspring of women with Eisenmenger syndrome (right-to-left shunting due to pulmonary hypertension induced by large congenital shunts), the mortality rate was 28%. Preterm delivery occurred in 22% to 65% of women with various forms of complex CHD. Overall, 3.5% of offspring were diagnosed with CHD.

Supraventricular arrhythmias were an important maternal cardiac complication and occurred most often in patients with palliated transposition of the great arteries, Fontan repair, or atrioventricular septal defects. Pregnancy-induced hypertension and preeclampsia were most common in patients with aortic coarctation, aortic stenosis, pulmonic stenosis, PAVSD, and transposition. Among women with Eisenmenger syndrome, the rate of heart failure was 21%, and the combined rate of myocardial infarction, stroke, and cardiovascular death was 33%.

Comment: Most studies in this review were retrospective and might have underestimated event rates; nevertheless, this analysis provides patients and healthcare providers with a solid assessment of the pregnancy-associated risks in women with CHD. Although most pregnancies resulted in normal births, serious cardiac complications were common among women with complex CHD. Pre-pregnancy consultation and obstetric care should be coordinated between obstetricians and cardiologists with expertise in adult CHD. In particular, women with Eisenmenger syndrome should be advised against becoming pregnant and should receive contraceptive guidance applicable to their condition.

— Marian C. Limacher, MD

Published in Journal Watch Women's Health August 16, 2007