Magalie Ladouceur1,2,3, Louise Benoit4, Jelena Radojevic5, Adeline Basquin6, Claire Dauphin7, Sébastien Hascoet8, Pamela Moceri9, Charlene Bredy10, Laurence Iserin1,2, Marielle Gouton1,11, Jacky Nizard4,12. 1. Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C. 2. Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes University, Paris, France. 3. Paris Cardiovascular Research Center (PARCC) INSERM U970, Paris, France. 4. Department of Obstetrics and Gynecology, Groupe hospitalier Pitié-Salpêtrière Paris, APHP, France. 5. Cardiologie congénitale, Strasbourg, France. 6. Cardiologie Pédiatrique et Congénitale, Service de cardiologie, CHU Rennes, France. 7. Cardiology Department, CHU Clermont-Ferrand, France. 8. Congenital Heart Diseases Department, Marie Lannelongue Hospital, Plessis-Robinson, France. Inserm UMR 1048, équipe 8-I2MC-institut des maladies métaboliques et cardiovasculaires, Paul-Sabatier University, Toulouse, France. 9. Cardiology Department, Hôpital Pasteur, Université de Nice Sophia-Antipolis, Nice, France. 10. Pediatric and Congenital Cardiology Unit, M3C Regional Reference Center, Montpellier University Hospital, Montpellier, France. 11. Congenital Heart Diseases department, Marie Lannelongue Hospital, Plessis-Robinson, France. 12. Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150, Paris, France.
Abstract
OBJECTIVE: There is growing evidence that maternal mortality in pregnant women with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is lower than that in available data. In order to evaluate this hypothesis, we collected data of pregnancies in women with PAH-CHD. METHODS: Women with PAH-CHD followed in seven French referral centres were retrospectively included from 1997 to 2015. All pregnancies were recorded. We collected data on maternal, obstetrical and neonatal outcomes. RESULTS: 28 pregnancies in 20 women (26±6 years old) with PAH-CHD were managed during this period. There were 18 complete pregnancies (≥20 weeks' gestation (WG)), 8 abortions and 2 miscarriages. Six (33%, 95% CI (11.9 to 54.3)) patients experienced severe cardiac events. The concerned women had lower resting oxygen saturation (79.6±4.1% vs 89.3±3.8%, p<0.01). The most common cardiac complications during the complete pregnancies were heart failure (n=4) and severe hypoxaemia (n=5). Heart failure was overall severe, requiring inotropic treatment in three patients, mechanical circulatory support in one and led to one maternal death (mortality=5.0% 95% CI (0.1 to 24.9)). Obstetrical complications occurred in 25% of pregnancies. Small for gestational age was diagnosed in 39% (7/18) of fetuses. 12/18 (67%) pregnancies were delivered by caesarean section, of which 10 in emergency for obstetrical reason. Prematurity was frequent (78%), but no neonatal death occurred. CONCLUSIONS: Outcome of pregnancy in women with PAH-CHD is better than previously reported, with only 5% maternal mortality in our cohort. However, because of the severity of heart failure and the high rate of neonatal complications, patients should still be advised against pregnancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: There is growing evidence that maternal mortality in pregnant women with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is lower than that in available data. In order to evaluate this hypothesis, we collected data of pregnancies in women with PAH-CHD. METHODS:Women with PAH-CHD followed in seven French referral centres were retrospectively included from 1997 to 2015. All pregnancies were recorded. We collected data on maternal, obstetrical and neonatal outcomes. RESULTS: 28 pregnancies in 20 women (26±6 years old) with PAH-CHD were managed during this period. There were 18 complete pregnancies (≥20 weeks' gestation (WG)), 8 abortions and 2 miscarriages. Six (33%, 95% CI (11.9 to 54.3)) patients experienced severe cardiac events. The concerned women had lower resting oxygen saturation (79.6±4.1% vs 89.3±3.8%, p<0.01). The most common cardiac complications during the complete pregnancies were heart failure (n=4) and severe hypoxaemia (n=5). Heart failure was overall severe, requiring inotropic treatment in three patients, mechanical circulatory support in one and led to one maternal death (mortality=5.0% 95% CI (0.1 to 24.9)). Obstetrical complications occurred in 25% of pregnancies. Small for gestational age was diagnosed in 39% (7/18) of fetuses. 12/18 (67%) pregnancies were delivered by caesarean section, of which 10 in emergency for obstetrical reason. Prematurity was frequent (78%), but no neonatal death occurred. CONCLUSIONS: Outcome of pregnancy in women with PAH-CHD is better than previously reported, with only 5% maternal mortality in our cohort. However, because of the severity of heart failure and the high rate of neonatal complications, patients should still be advised against pregnancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.