April 5, 2016Open Access

Cardiac adaption during pregnancy in women with congenital heart disease and healthy women

Structured PICO

Does pregnancy cause deterioration in cardiac function and dimensions in women with congenital heart disease compared to healthy pregnant women?

Population

174 pregnant women, comprising 125 women with structural congenital heart disease (CHD) (excluding systemic right ventricle or Fontan physiology) and 49 healthy pregnant controls. Mean age ~29-30 years, mostly nulliparous (~61-62%). Recruited from eight tertiary centres and low-risk midwife practices in the Netherlands.

Intervention

Pregnancy in women with congenital heart disease (monitored via standardized echocardiography at 20 and 32 weeks gestation and 1 year postpartum)

Comparator

Pregnancy in healthy women (controls recruited from low-risk midwife practices)

Outcome

Serial changes in cardiac dimensions and function (including LVEF, TAPSE, RVEDD, LVEDD, and systolic tissue velocities) measured by standardized echocardiography at 20 and 32 weeks gestation and 1 year postpartumsurrogate

Pregnancy in women with congenital heart disease does not generally lead to permanent deterioration of cardiac function, though absolute ventricular function is lower than in healthy women and specific lesion types show distinct remodeling patterns.

Abstract

OBJECTIVE: Pregnancy in women with congenital heart disease (CHD) is associated with deterioration in cardiac function. However, longitudinal data are scarce. This study describes serial changes in cardiac dimensions and function during pregnancy in women with CHD and compares these with healthy pregnant women (controls). METHODS: Eight tertiary centres prospectively enrolled 125 pregnant women with CHD (pregnancy duration 0.1). Left ventricular ejection fraction (LVEF) <45% was present in 3.2% of women with CHD and 14.4% had tricuspid annular plane systolic excursion (TAPSE) <16 mm. Absolute values of ventricular function parameters and diameters were less favourable in women with CHD. No permanent changes occurred in right and left ventricular function parameters and dimensions in women with CHD. The patterns of change in cardiac function and dimensions were comparable between women with CHD and controls, except for LVEF (p=0.026). In women with right-sided CHD the pattern of TAPSE over time differed from controls (p=0.043) (no decrease in TAPSE postpregnancy in CHD). In women with left-sided CHD left ventricular end-diastolic diameter (LVEDD) tended to increase compared with controls (p=0.045). CONCLUSIONS: Absolute levels of ventricular function parameters and diameters differ between CHD and controls, but changes during and after pregnancy are generally comparable. However, different patterns over time seen for TAPSE and LVEDD in women with right-sided and left-sided CHD, respectively, compared with controls indicate the importance of echocardiographic follow-up during pregnancy in women with CHD.

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