Pregnancy outcomes in patients with repaired/unrepaired coarctation of aorta: results from a large tertiary cardiovascular center

Introduction Coarctation of aorta is still considered as an important contributor to cardiovascular, obstetric and fetal adverse events during pregnancy. The residual hypertension and a greater susceptibility to heart failure and premature coronary artery disease, place the disease even at its repaired form, as a moderately-increased risk condition for pregnancy. However, the available recommendations are based on limited evidence. In the present study, pregnancy-related maternal and fetal adverse events and their contributors were analyzed in patients with repaired and unrepaired coarctation of aorta. Methods In this retrospective cohort, all consecutive patients with repaired/unrepaired coarctation of aorta referred to cardio-obstetrics clinic between 2010 and 2024 were included. Baseline demographic, clinical, diagnostic and obstetric characteristics were primarily retrieved using electronic records. Missing baseline and outcome-related data were completed via phone call interviews, and the received outcomes were only acceptable if adjudicated by the main investigators. Results In the current study, 64 patients with a total of 156 pregnancies were included, of which 102 and 54 pregnancies were proceeded during unrepaired and repaired coarctation of aorta. Of note 22 patients, experienced both repaired and unrepaired conditions during different pregnancies. Baseline characteristics were summarized in Table 1. Different components of cardiovascular, obstetric and fetal outcomes were shown in Table 2. Briefly, no mortality was reported during pregnancies and a significantly higher obstetric composite outcome and a trend toward higher cardiovascular composite outcome were observed in pregnancies without coarctation of aorta repair. No difference was detected between fetal outcomes in both groups. Interestingly, hypertension-related adverse events were significantly higher in patients without coarctation repair. Rate of abortion (4 (7.4%) versus 11 (10.8%) patients, (p=0.50) and miscarriage (9 (16.7%) versus 15 (14.7%), p=0.74) following pregnancy were not statistically different in patients with repaired and unrepaired coarctation of aorta. Conclusion Despite no observed mortality, coarctation repair potentially impact on cardiovascular and obstetric outcomes, mainly hypertensive adverse events. Still about one fifth of pregnancies in both patients with repaired and unrepaired of aorta resulted in miscarriage/abortion confirming the previous consensus categorizing coarctation of aorta as at least moderately increased risk condition for pregnancy.