Pregnancy-related outcomes in patients with repaired versus unrepaired coarctation of the aorta: the PEARL retrospective cohort study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Coarctation of the aorta in pregnancy (n=157). Intervention: Unrepaired coarctation of the aorta vs. Repaired coarctation of the aorta. Primary outcome: Composite obstetric outcomes (OR 3.45, 95% CI 1.15-11.46, p=0.03).

Q: What does this research mean for the field?

Unrepaired coarctation of the aorta significantly increases composite obstetric complications during pregnancy compared with repaired coarctation, driven predominantly by hypertension-related adverse events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mona Yadollahi; Mohammadreza Babaei; Sara Montazeri Namin; Nasrin Ghadakkar; Mahshad Sabri; Soudabeh Shafiee Ardestani; Fahimeh Kashfi; Hooman Bakhshandeh; Mahdi Daliri; Niloufar Samiei; Majid Kyavar; Alain Fraisse; Parham Sadeghipour

doi:10.1186/s12872-026-06925-z

November 3, 2026BMC Cardiovascular DisordersOpen Access

Pregnancy-related outcomes in patients with repaired versus unrepaired coarctation of the aorta: the PEARL retrospective cohort study

View Full Paper

Ask AI

Bookmark

Share

Key result

Unrepaired aortic coarctation linked to ~3.5-fold higher obstetric complications versus repaired coarctation.

OR 3.45
95% CI 1.15-11.46
P=0.03
n=157

Why the study?

Does unrepaired coarctation of the aorta compared to repaired coarctation of the aorta increase the risk of maternal cardiovascular, obstetric, and fetal complications in pregnant women?

Key Points

To compare maternal cardiovascular, obstetric, and fetal outcomes during pregnancy between women with repaired versus unrepaired coarctation of the aorta.
Retrospective cohort study conducted at a single-center tertiary cardiovascular hospital from 2010 to 2024, analyzing 157 pregnancies (103 unrepaired vs. 54 repaired CoA) in 64 patients.
Outcomes across maternal cardiovascular, obstetric, and fetal categories were evaluated using penalized regression models adjusted for clinical confounders.
Composite obstetric complications occurred significantly more often in unrepaired versus repaired CoA (31 [30.1%] vs. 6 [11.1%]; adjusted OR, 3.45; 95% CI, 1.15 to 11.46; P=0.03), led by higher rates of preterm labor (15 [14.6%] vs. 2 [3.7%]; adjusted OR, 6.08; 95% CI, 1.31 to 40.84; P=0.02).
Composite maternal cardiovascular events occurred in 30 (29.1%) unrepaired versus 5 (9.3%) repaired pregnancies, with no statistically significant difference after adjustment (adjusted OR, 1.76; 95% CI, 0.57 to 6.18; P=0.33), predominantly driven by hospitalization for uncontrolled hypertension (27 [26.2%] vs. 2 [3.7%]).
Composite fetal complications were similar between unrepaired and repaired groups (19 [18.4%] vs. 8 [14.8%]; adjusted OR, 0.77; 95% CI, 0.23 to 2.69; P=0.68), and no maternal deaths occurred.

Study Design

Type

Cohort (n=157)

Multicenter

No

Structured PICO

Does unrepaired coarctation of the aorta compared to repaired coarctation of the aorta increase the risk of maternal cardiovascular, obstetric, and fetal complications in pregnant women?

P

Population

157 pregnancies in 64 women (median age 28 years) with confirmed repaired or unrepaired coarctation of the aorta managed at a single tertiary cardiovascular center in Iran between 2010 and 2024.

E

Exposure

Unrepaired coarctation of the aorta during pregnancy (n=103 pregnancies; median peak pressure gradient 60 mmHg [IQR 54-76]), managed by a multidisciplinary cardio-obstetrics team

C

Comparator

Repaired coarctation of the aorta (n=54 pregnancies; 52 with surgical or endovascular repair prior to pregnancy and 2 repaired during pregnancy; median time elapsed since repair 9 years [IQR 3-24]; median peak pressure gradient 16 mmHg [IQR 12-19]), managed by the same multidisciplinary cardio-obstetrics team

O

Outcome

Composite maternal cardiovascular outcomes (hospitalization for uncontrolled hypertension, acute aortic syndrome, heart failure hospitalization, thromboembolic events, acute coronary syndrome, cardiovascular mortality, infective endocarditis, malignant arrhythmia), composite obstetric outcomes (gestational hypertension, preeclampsia, eclampsia or HELLP, gestational diabetes mellitus, preterm labor, placenta rupture, premature rupture of membranes, oligohydramnios), and composite fetal outcomes (low birth weight, intrauterine growth restriction, intrauterine fetal demise, neonatal death, neonatal intensive care unit admission, fetal congenital heart disease) through delivery and at least 6 months postpartum, adjudicated by three investigators.composite

Main Result

Odds Ratio: 3.45 (95% CI 1.15–11.46)

Absolute Event Rate: 30.1% vs 11.1%

p-value: p=0.03

Limitations

Retrospective design limits causal inference and introduces potential unmeasured confounding and recall bias.
Single-center tertiary referral setting with patients having hemodynamically significant obstruction limits generalizability to less severe forms of coarctation.
Relatively small sample size and potential referral bias.
No statistical adjustment was made for clustering of multiple pregnancies within the same patient.
Retrospective cohort design
Single-center study
Each pregnancy was treated as an independent observation with no statistical adjustment made for clustering within patients
Small sample size and low event rates limiting definitive conclusions on rare outcomes such as acute aortic syndromes

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

In the largest cohort evaluation of pregnant women with unrepaired coarctation of the aorta, unrepaired status significantly increased the risk of obstetric and hypertension-related complications compared to repaired CoA, though fatal or severe structural cardiac events remained rare under multidisciplinary care.

Abstract

Background Coarctation of the aorta (CoA) poses a unique challenge during pregnancy, with limited evidence on management, particularly in patients with unrepaired CoA. Aim To compare maternal cardiovascular, obstetric, and fetal outcomes in pregnant women with repaired versus unrepaired CoA. Methods We conducted a retrospective cohort study at a large single-center tertiary cardiovascular hospital from 2010 to 2024, including all pregnancies with confirmed repaired or unrepaired CoA. Clinical data from electronic records were analyzed for maternal, obstetric, and fetal complications. Pregnancy outcomes were compared between repaired and unrepaired CoA groups using penalized regression models, with adjusted odds ratios (OR) reported for clinically relevant confounders. Results A total of 157 pregnancies (103 unrepaired vs. 54 repaired CoA) were included, with a median maternal age of 28 years (IQR, 24 to 33) at pregnancy. Maternal cardiovascular, obstetric, and fetal complications occurred in 35 (22.3%), 37 (23.6%), and 27 (17.2%) pregnancies, respectively. Major adverse cardiac events were rare (5.1%) and nonfatal. Composite maternal cardiovascular and obstetric outcomes occurred more frequently in the unrepaired group (30 [29%] vs. 5 [9%]) and 31 [30%] vs. 6 [11%], whereas composite fetal outcomes were similar (19 [18%] vs. 8 [15%]). Women with unrepaired CoA had higher rates of hypertension-related complications, including hospitalization for uncontrolled hypertension (27 [26%] vs. 2 [4%]), gestational hypertension (20 [20%] vs. 0 [0%]), and preeclampsia (14 [14%] vs. 1 [2%]). Preterm labor occurred more frequently in the unrepaired group than the repaired group (15 [14.6%] vs. 2 [3.7%]). Conclusion Pregnant women with unrepaired CoA showed a trend toward higher maternal cardiovascular complications and significantly higher obstetric complications in comparison with repaired CoA, primarily due to increased hypertension-related adverse events. Although severe cardiovascular events were rare, the elevated risk emphasizes the need for early diagnosis, timely repair, and comprehensive care during pregnancy. Trial registration Not applicable.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Yadollahi et al. (2026) conducted a cohort in Coarctation of the aorta in pregnancy (n=157). Unrepaired coarctation of the aorta vs. Repaired coarctation of the aorta was evaluated on Composite obstetric outcomes (OR 3.45, 95% CI 1.15-11.46, p=0.03). Unrepaired coarctation of the aorta significantly increased composite obstetric complications compared with repaired coarctation (30.1% vs 11.1%; adjusted OR 3.45, 95% CI 1.15-11.46; P=0.03).

synapsesocial.com/papers/6aeb260a7efe0c3bfbad2882 https://doi.org/10.1186/s12872-026-06925-z

View Full Paper

Ask AI

Bookmark

Share

Pregnancy-related outcomes in patients with repaired versus unrepaired coarctation of the aorta: the PEARL retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Pregnancy-related outcomes in patients with repaired versus unrepaired coarctation of the aorta: the PEARL retrospective cohort study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading