Pregnancy outcomes in women with aortic coarctation

Ramlakhan, Karishma P; Tobler, Daniel; Greutmann, Matthias; Schwerzmann, Markus; Baris, Lucia; Yetman, Anji T; Nihoyannopoulos, Petros; Manga, Pravin; Boersma, Eric; Maggioni, Aldo P; Johnson, Mark R; Hall, Roger; Roos-Hesselink, Jolien W (2020). Pregnancy outcomes in women with aortic coarctation (In Press). Heart BMJ Publishing Group 10.1136/heartjnl-2020-317513

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Objective: Pregnancy 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.

Methods: Pregnancies 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.

Results: Of 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 <40% (OR 10.4, 95% CI 1.8 to 59.5), New York Heart Association class >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.

Conclusions: The 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.

Keywords: aortic coarctation; congenital heart disease; pregnancy.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Schwerzmann, Markus

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1355-6037

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Markus Schwerzmann

Date Deposited:

29 Dec 2020 10:08

Last Modified:

24 Feb 2021 09:10

Publisher DOI:

10.1136/heartjnl-2020-317513

PubMed ID:

33122301

BORIS DOI:

10.48350/149094

URI:

https://boris.unibe.ch/id/eprint/149094

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