Pregnancy Outcomes in Adult Congenital Heart Disease Patients with Pulmonary Hypertension in Indonesia

Congenital heart disease (CHD) and pulmonary hypertension represent significant risk factors for adverse pregnancy outcomes and are associated with considerable maternal mortality, contributing to approximately 9% of maternal deaths globally. Among cardiovascular diseases complicating pregnancy, CHD is the most prevalent subtype. Here we conducted a comprehensive literature review on maternal and foetal outcomes associated with adult CHD-related pulmonary hypertension, also incorporating data from four pulmonary hypertension centres in Indonesia. Consistent with global epidemiological trends, atrial septal defect emerged as the most frequently observed form of CHD, followed by ventricular septal defect, across the four Indonesian centres. Maternal cardiovascular complications in this context include heart failure, arrhythmias, pulmonary hypertensive crises, thromboembolic events and aortic dissection. These haemodynamic disturbances further elevate the risk of adverse foetal outcomes, such as prematurity, low birth weight, intrauterine growth restriction and foetal demise. Effective and timely management of CHD and pulmonary hypertension – centred on optimising right ventricular function during pregnancy – is critical. Implementation of a comprehensive, multidisciplinary care approach, alongside the expansion of screening programmes for CHD in pregnant populations, is essential to improve maternal and foetal outcomes.