Key result
Pregnancies with BAV and aortopathy carry ~7% major cardiac event risk with stable aortic dimensions.
Why the study?
No prospective data had been collected on pregnant women with bicuspid aortopathy, in whom identifying those at high risk for pregnancy-related events was warranted.
Pregnancy in women with bicuspid aortic valve and aortopathy is associated with a low overall event rate and no significant aortic growth, though aortic dissections can occur even with mild dilatation.
Supports low-risk counseling for bicuspid aortic valve pregnancies yet cautions on dissection risk even with mild dilation; leaves open refined risk predictors.
Background Patients with a bicuspid aortic valve (BAV) have been studied extensively during the last decades. However, no prospective data has been collected on pregnant women with bicuspid aortopathy. Aortic dilatation and aortic coarctation are common in these women and identifying women at high risk for pregnancy-related events is warranted. Purpose The aim of this study is to prospectively investigate pregnancy outcomes in women with a BAV and aorta pathology to ultimately improve patient management and care. Methods The Registry of Pregnancy and Cardiac Disease III is a prospective global registry including pregnant women with aortic pathology between 2018 and 2023. Women with heritable thoracic aortic disease or Turner syndrome were excluded from this cohort. Adverse cardiac, obstetric or fetal outcomes were recorded, as well as changes in aortic diameter, beta-blockers use and details on breastfeeding. Results In total, 157 pregnancies in 145 women were included (mean age 31 years, 49% primigravida), of which 82 were diagnosed with mild to severe dilatation (≥36mm) of the thoracic ascending aorta before or during pregnancy, 61 had (repaired) aortic coarctation, and 14 had both. A total of 18 women had a severely dilated aorta (≥45mm) and 43 women had a moderately dilated aorta (41-44mm). There was no maternal mortality, while ten fetal deaths and one neonatal death occurred. Overall, 11 (7%) major adverse cardiac events were observed (Table 1), of which two type A aortic dissections both in the mild dilatation group (without coarctation). They both had an aortic diameter of 40mm before pregnancy (one and three years prior to this pregnancy). Delivery by Caesarean section occurred in 82 (55%) women with the highest percentage in the severe dilatation group (77%). Only 16 (12%) women used beta-blockers throughout pregnancy: seven women with aortic dilatation and nine women with (repaired) coarctation. This group experienced no major adverse cardiac events. Although not a significant difference, the median offspring birth weight from women taking beta-blockers was 130 grams lower than from women not taking beta-blockers. There were no adverse events recorded during the postpartum period in the group of 74 (67%) breastfeeding women. The aorta measurements of the whole cohort are graphically presented in Figure 1. No significant growth over time was found at any of the segments. Conclusion The overall event rate in women with a BAV and aortic pathology is low, but dissections do occur. No significant aortic growth seems to happen during the time course of an individual pregnancy and there is no need to advise these women against breastfeeding. Pre-pregnancy counselling and close monitoring during pregnancy remains essential.
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Peters et al. (2025) studied this question. In 157 pregnancies with BAV and aortopathy, 7% had major cardiac events including 2 dissections; no maternal deaths occurred and aortic growth during pregnancy was not significant.
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