March 1, 1999Heart109 citationsOpen Access

Outcome of pregnancy in women with congenital shunt lesions

MZMichel ZüberUniversity Hospital of Zurich NGN. GautschiUniversity Hospital of Bern EOErwin OechslinAdult Congenital Heart Disease

Structured PICO

What are the maternal and fetal outcomes of pregnancy in women with congenital shunt lesions?

Population

126 women with congenital shunt lesions who had pregnancies (from a cohort of 175 women), mean age 42 (SD 14) years. Lesions included atrial septal defect (n=50), ventricular septal defect (n=22), atrioventricular septal defect (n=22), tetralogy of Fallot (n=19), and other complex shunt lesions (n=13).

Outcome

Pregnancy outcomes including spontaneous abortions, gestational age, maternal deaths, pre-eclampsia, embolic events, mode of delivery, birth weight, and recurrence risk of congenital heart disease.hard clinical

Pregnancy in women with congenital shunt lesions is generally safe with favorable outcomes, provided functional class and systolic ventricular function are well-preserved, though complex lesions carry higher risks of caesarean section and lower birth weights.

Abstract

OBJECTIVE: To evaluate the outcome of pregnancy in women with congenital shunt lesions. SETTING: Retrospective study in a tertiary care centre. METHODS: Pregnancy history was obtained by a standardised questionnaire and medical records were reviewed. PATIENTS: 175 women were identified, at a mean (SD) age of 42 (14) years. Pregnancies occurred in 126 women: 50 with an atrial septal defect, 22 with a ventricular septal defect, 22 with an atrioventricular septal defect, 19 with tetralogy of Fallot, and 13 with other complex shunt lesions. RESULTS: 309 pregnancies were reported by 126 woman (2.5 (1.6) pregnancies per woman). The shortening fraction of the systemic ventricle was 40 (8)%, and 98% were in New York Heart Association class I-II at last follow up. Spontaneous abortions occurred in 17% of pregnancies (abortion rate, 0.4 (0.9) per woman). Gestational age of the 241 newborn infants was 8.8 (0.8) months. There were no maternal deaths related to pregnancy. Pre-eclampsia and embolic events were observed in 1.3% and 0.6%, respectively of all pregnancies. Women with complex shunt lesions more often underwent caesarean section (70% v 15-30%, p = 0.005) and gave birth to smaller babies for equivalent gestation (2577 (671) g v 3016 (572) to 3207 (610) g, p < 0.05). The recurrence risk of congenital heart disease was 2.5%. CONCLUSIONS: The outcome of pregnancy is favourable in women with congenital shunt lesions if their functional class and their systolic ventricular function are good. Such patients can be reassured.

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