4.5 Article

Pregnancy outcomes in women with aortic coarctation

Journal

HEART
Volume 107, Issue 4, Pages 290-298

Publisher

BMJ PUBLISHING GROUP
DOI: 10.1136/heartjnl-2020-317513

Keywords

aortic coarctation; pregnancy; congenital heart disease

Funding

  1. Zabawas Foundation
  2. De Hoop Foundation
  3. EORP
  4. Abbott Vascular Int.
  5. Amgen Cardiovascular
  6. AstraZeneca
  7. Bayer AG
  8. Boehringer Ingelheim
  9. Boston Scientific
  10. Bristol Myers Squibb
  11. Pfizer Alliance
  12. Daiichi Sankyo Europe GmbH
  13. Alliance Daiichi Sankyo Europe GmbH
  14. Eli Lilly and Company
  15. Edwards
  16. Gedeon Richter Plc.
  17. Menarini Int. Op.
  18. MSD-Merck Co.
  19. Novartis Pharma AG
  20. ResMed
  21. Sanofi
  22. SERVIER
  23. Vifor

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The study examined outcomes of pregnancy in women with aortic coarctation and found low rates of MACE and hypertensive disorders, suggesting pregnancy in these women may be safer and better tolerated than previously appreciated.
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.

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