Key result
Pregnancy increases peak LVOTO gradients by ~9 mm Hg without associated adverse obstetric outcomes.
Why the study?
Physiological adaptations of pregnancy increase the LVOTO gradient, altering risk perception, but whether gradient changes associate with worse outcomes or reverse postpartum remains unclear.
Does an increase in LVOTO gradient during pregnancy predict adverse maternal-fetal outcomes in women with left ventricular outflow tract obstruction?
Observational (n=100)
Yes
Does an increase in LVOTO gradient during pregnancy predict adverse maternal-fetal outcomes in women with left ventricular outflow tract obstruction?
The physiological increase in LVOT gradients during pregnancy in women with LVOTO is not associated with adverse obstetric outcomes, suggesting that gradient increases alone should not alter clinical risk perception.
Gradient increases alone should not alter obstetric risk perception in LVOTO; leaves open confirmation in larger prospective cohorts.
Background Women with left ventricular outflow tract obstruction (LVOTO) are at risk of adverse pregnancy outcomes, which have been related to the severity of the LVOTO. However, the physiological adaptations of pregnancy increase the gradient across an LVOTO, often altering the clinical perception of risk. Here, we examined how the LVOTO gradient changes during pregnancy, investigating whether a greater increase in the gradient is associated with worse pregnancy outcome and whether any increase in the gradient is transient, reversing after the end of the pregnancy. Methods The study was conducted at three tertiary centres. Data were collected from 125 pregnancies in 100 women with a range of causes of LVOTO, including bicuspid aortic valve (n=71), trileaflet aortic stenosis (n=23), prosthetic valve replacement (n=18) and subvalvular stenosis (n=8). Measurements included echocardiographic parameters (peak and mean LVOT gradients, left ventricular ejection fraction) and pregnancy outcomes. The primary endpoints were the change in gradient and pregnancy outcomes. Results The mean (19.5±11.9 mm Hg to 23.8±14.9 mm Hg) and peak (31.6±19.2 mm Hg to 40.6±27.7 mm Hg) gradients increased significantly during pregnancy and in a minority of cases this rise persisted postpartum. Pregnancy complications were unrelated to baseline gradient severity or the increase in gradient observed during pregnancy. Counter to our hypothesis, there was no association between the increase in gradient and adverse pregnancy outcomes. Conclusions The physiological changes of pregnancy resulted in an increase in the gradient across the LVOTO, which was not associated with any adverse obstetric outcomes. In some cases, the increase in the gradient only partially reversed after pregnancy, implying that pregnancy may induce a structural change in the lesion, giving rise to LVOTO.
No takes yet. Share an insight, caveat, or question.
Wander et al. (2026) conducted an observational in Left ventricular outflow tract obstruction in pregnancy (n=100). Pregnancy-induced physiological changes vs. Baseline (pre-pregnancy) was evaluated on Change in gradient and pregnancy outcomes. Pregnancy significantly increased mean (19.5 to 23.8 mm Hg) and peak (31.6 to 40.6 mm Hg) LVOTO gradients, but this increase was not associated with adverse obstetric outcomes.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: