Key result
Pregnant women with uncorrected tetralogy of Fallot experienced a significantly higher rate of premature birth compared to those with surgically repaired defects (50% vs 5.26%, p=0.007).
Why the study?
Tetralogy of Fallot confers substantial risk to mother and fetus during pregnancy, but pregnancy outcomes in women with TOF have not been well studied.
Does surgical correction of tetralogy of Fallot improve maternal and perinatal outcomes in pregnant women compared to uncorrected tetralogy of Fallot?
Cohort (n=31)
No
Does surgical correction of tetralogy of Fallot improve maternal and perinatal outcomes in pregnant women compared to uncorrected tetralogy of Fallot?
Absolute Event Rate: 50% vs 5.26%
p-value: p=0.007
Surgical correction of tetralogy of Fallot prior to pregnancy significantly reduces the risk of adverse maternal and perinatal outcomes, such as prematurity and low birth weight, compared to uncorrected TOF.
May support preconception TOF repair to lower prematurity risk; leaves open whether association is causal.
BACKGROUND: Tetralogy of Fallot (TOF) is a severe type of congenital heart disease (CHD) and it confers substantial risk to mother and fetus for pregnant women. However, the outcome of pregnancy in women with TOF has not been well studied. METHODS: Women with TOF who have been seen and/or delivered at our tertiary-care hospital between April 2008 and January 2018 were retrospective reviewed. RESULTS: A total of 31 pregnant women with TOF were identified during ten-year period. Among these patients, cardiac defects remained uncorrected in 12 women and were surgically repaired in 19 women. The frequency of miscarriages, premature birth, and the percentage of neonates of small for gestational age (SGA) were greater in the uncorrected group than the surgically repaired group (16.67% vs 0, 50% vs 5.26, 41.67% vs 10.53% respectively). The neonatal mortality and fetal mortality were not observed in the surgically repaired group, but were observed in the uncorrected group [3.23% (1/31) and 6.45(2/31) respectively]. Furthermore, the obstetric and cardiac complications in the two groups were stratified and analyzed. CONCLUSIONS: Surgical correction of TOF is associated with improved maternal and perinatal outcome. However, pregnancy in women with uncorrected TOF was still seen and it was observed at a rate of 1.4/10,000 in our medical center during ten year period. The high degree of ventricular dilatation heart, high functional classifications, serious cardiac arrhythmias and pulmonary hypertension appeared to be associated with maternal and neonatal risks.
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Wang et al. (2019) conducted a cohort in Tetralogy of Fallot in pregnancy (n=31). Uncorrected tetralogy of Fallot vs. Surgically repaired tetralogy of Fallot was evaluated on Prematurity (p=0.007). Pregnant women with uncorrected tetralogy of Fallot experienced a significantly higher rate of premature birth compared to those with surgically repaired defects (50% vs 5.26%, p=0.007).
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