Key result
Among women with Fontan physiology, 37% had a documented pregnancy, with 13 of 19 first pregnancies resulting in a live birth, though fetal complications such as prematurity were highly prevalent.
Why the study?
Data on the characteristics and outcomes of pregnancy among patients with Fontan physiology are limited.
Cohort (n=109)
No
Pregnancy in women post-Fontan surgery is associated with high rates of fetal complications such as prematurity and intrauterine growth retardation, as well as notable maternal complications, highlighting the need for specialized care.
Adds sparse Fontan pregnancy data; leaves open need for prospective studies to refine risk stratification.
INTRODUCTION: Data on the characteristics and outcomes of pregnancy and among patients with Fontan physiology are limited. We aimed to evaluate the immediate and long-term outcomes among these patients who were followed at our centre. METHODS: We included adult patients who had undergone Fontan surgery for congenital heart disease and were pregnant between 1994 and 2021. We examined maternal and obstetric outcomes. RESULTS: In a cohort of 109 patients following Fontan procedure, 51 patients were women, and 19 patients (37%) had a pregnancy during the follow-up period, accounting for a total of 46 pregnancies. Intrauterine growth retardation of the fetus was common, observed in 23% of all pregnancies and 50% of live births. The main fetal complication was prematurity, observed in 43% of all pregnancies and 90% of live birth. The maternal complications included pre-eclampsia (one patient), placental detachment (one patient), acute heart failure exacerbation (one patient), arrhythmia (three atrial arrhythmias) and major peripartum haemorrhage (two patients), with no peripartum death. CONCLUSIONS: Over one-third of women with Fontan physiology in our cohort had a documented pregnancy. Maternal and obstetric complications were common among these patients, and expanded long-term data is needed. Limitations, including small sample size and survival bias, may have underestimated the risk of adverse outcomes in this cohort.
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Yehuda et al. (2025) conducted a cohort in Congenital heart disease post Fontan surgery (n=109). Pregnancy was evaluated on Live birth versus miscarriage with the first pregnancy. Among women with Fontan physiology, 37% had a documented pregnancy, with 13 of 19 first pregnancies resulting in a live birth, though fetal complications such as prematurity were highly prevalent.
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