Key result
Pregnancy in women with Turner syndrome was not associated with any adverse cardiovascular events, with 0 events occurring in both pregnant and non-pregnant groups.
Why the study?
Women with Turner syndrome are frequently counselled against pregnancy because of limited data and unclear aortic dissection risk, despite more women contemplating pregnancy with advances in fertility therapy.
Does pregnancy increase the risk of adverse cardiovascular events in women with Turner syndrome?
Cohort (n=60)
Yes
Does pregnancy increase the risk of adverse cardiovascular events in women with Turner syndrome?
Absolute Event Rate: 0% vs 0%
Pregnancy in women with Turner syndrome, particularly those without structural heart disease, does not appear to impose an increased risk of acute cardiovascular events such as aortic dissection, challenging previous prohibitive counseling.
No CV events in selected TS pregnancies vs controls; leaves open broader risk assessment and need for prospective data before changing counseling.
OBJECTIVES: Women with Turner syndrome (TS) are frequently counselled against pregnancy due to lack of data and unclear aortic dissection risk. However, with advances in fertility therapy, more women with TS are contemplating pregnancy. This study compared rates of adverse cardiovascular (CV) outcomes among: (1) pregnant and non-pregnant women with TS and (2) pregnant women with TS with/without structural heart disease. METHODS: Retrospective analysis of pregnant and age-matched non-pregnant controls with TS (2005-2017) across 10 CV centres was done. Data were collected at initial evaluation in pregnancy and outcomes were assessed to 6 months postpartum. Adverse CV events were defined as CV death, aortic dissection/rupture and/or aortic intervention. Non-pregnant age-matched controls were followed over the same time period. RESULTS: Sixty-eight pregnancies were included (60 women, mean age 33 years, 48% primigravid, 49% fertility therapy, 80% structurally normal heart, 25% XO karyotype). Based on American Society of Reproductive Medicine criteria, 10 pregnancies occurred in women stratified to high-risk category. There were no CV events in the pregnant women or in the non-pregnant women with TS. Obstetric events complicated 12 (18%) pregnancies with 9 (13%) attributed to hypertensive disorder of pregnancy. Fetal events included small for gestational age neonates (18%), preterm delivery (15%) and fetal death (3%). CONCLUSIONS: This study helps to refine the approach to pregnancy in women with TS. Among women with TS without structural heart disease, pregnancy does not impose an increased risk of CV outcomes. Among women with TS with structural heart disease, the risk of pregnancy is not as prohibitive as previously described but does require ongoing evaluation.
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Grewal et al. (2020) conducted a cohort in Turner syndrome (n=60). Pregnancy vs. Non-pregnant women with Turner syndrome was evaluated on Adverse CV events (CV death, aortic dissection/rupture and/or aortic intervention). Pregnancy in women with Turner syndrome was not associated with any adverse cardiovascular events, with 0 events occurring in both pregnant and non-pregnant groups.
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