Pregnancy Results for Women with Congenital Heart Disease Better Than Anticipated

Women with congenital heart disease experience complications at rates that are lower than many experts may currently believe, suggests a study presented here on November 1st at the American Academy of Pediatrics (AAP) National Conference and Exhibition.

Heart disease is diagnosed in 1 to 3% of women before or during pregnancy. Among these women, 75% have congenital heart disease. Lead by Frank Cetta, MD, of the Mayo Clinic in Rochester, Minnesota, United States, the researchers performed a chart review to assess maternal morbidity and mortality, miscarriage and premature birth rates in 324 women with congenital heart disease. Study subjects were divided into two groups, women advised not to become pregnant and women who were advised that pregnancy was safe. Patients were a mean age of 37.8 years, and 92% were Warnes-Somerville Class 1.

One hundred and thirty nine women became pregnant, for a total of 300 pregnancies. Overall, 47 of these women had been counselled not to get pregnant. Among these very high risk patients, 17 became pregnant against medical advice.

No mortality, endocarditis or strokes occurred among the women. Complications included eight arrhythmias, two pacemaker malfunctions, one coumadin-related haemorrhage, two cases of congestive heart failure and one mitral valvuloplasty.

Overall, there were 250 (71%) healthy, full-term births and 25 (7%) premature births. Additionally, 69 (20%) spontaneous abortions occurred. Three women elected to have abortions and there were six neonatal deaths.

Not surprisingly, spontaneous abortions trended higher and preterm births were significantly more common in the group of women advised not to become pregnant (p=0.38 and 0.03, respectively). Furthermore, the severity of infant prematurity trended higher in this group (p=0.27)

While Dr. Cetta does not recommend pregnancy in women with pulmonary hypertension, Eisenmenger’s syndrome, severe heart failure, or high grade stenoses, he believes that based on these results, cardiologists may be too stringent in advising women against pregnancy.

“Maybe we need to reevaluate some of those factors for women who do better than we think they are going to do,” Dr. Cetta told Doctor’s Guide. “More studies should evaluate the group of women who are marginal as to whether they should get pregnant or not.”