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Pregnancy outcomes in women with severe congenital heart disease - a specialized centre experience
Session:
Comunicações Orais (Sessão 24) - Cardiopatias Congénitas, Doença Vascular Pulmonar e Embolia Pulmonar 2 - Foco no Adulto com Cardiopatia Congénita
Speaker:
Vera Vaz Ferreira
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.2 Congenital Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Vera Ferreira; Tânia Branco Mano; Tiago Rito; Ana Agapito; Alexandra Castelo; Pedro Garcia Brás; Rita Ilhão Moreira; Fátima Pinto; Lídia Sousa
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong><strong>:</strong> Progress in pediatric cardiology and cardiac surgery has dramatically increased the number of women with severe complex congenital heart disease (SC-CHD) that reach reproductive age. Pregnancy in this group of women has an increased risk of adverse cardiac and neonatal events and its predictive factors are not fully defined. Our purpose was to assess the experience of our center regarding pregnancy and neonatal outcomes in women with SC-CHD.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective analysis of obstetric data in women with CHD followed at our institution. Pregnancy and neonatal outcomes were evaluated regarding patients presenting SC-CHD and mild and moderate complexity (MMC-CHD), <span style="color:black">according to ESC CHD guidelines classification.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> The study enrolled 680 women with CHD (median age, 27.2 years) who experienced 1262 pregnancies, resulting in 998 live births. A previous corrective procedure was found in 334 women (49.1%). CHD complexity was considered mild, moderate and severe in 263 (38.7%), 359 (52.8%) and 58 (8.5%), respectively. SC-CHD included 38 women with cyanotic CHD and 18 with pulmonary vascular disease. The most common heart defect in SC-CHD patients was cyanotic tetralogy of Fallot (19%), followed by dextro-transposition of the great arteries with atrial switch /palliative procedures (13.8%) - Figure 1. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients with SC-CHD had successful deliveries in 56.1% comparing with 82.1% in MMC-CHD. Women with SC-CHD had significantly higher incidence of preterm birth (24.6% vs 7.4%, p<0.001), spontaneous abortion (26.3% vs 12.3%, p=0.004) and neonatal mortality (10.3% vs 2.3%) comparing with MMC-CHD. Low birth weight was also extremely more frequent in the SC-CHD group (44.7% vs 8.5%, p<0.001). No difference was found relating to the presence of CHD in infants from SC-CHD mothers compared to off-spring from MMC-CHD (8.4 vs 5.3%, p=0.407). Cesarian deliveries had similar rates independently of increased CHD complexity (34.2% vs 32.1%). Overall, pregnancy was quite well tolerated, although cardiac complications were more common in SC-CHD pregnancies (0.4% vs 4.3%, p 0.013). Only one maternal death was registered, during 1<sup>st </sup>trimester, in a woman with a large unrepaired ventricular septal defect and cyanosis. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Severe complex CHD remains a challenging condition for pregnancy with increased maternal and neonatal morbimortality. This emphasizes the importance of extensive prepregnancy counselling and centralization of care to address specific risks and requirements of the condition.</span></span></p>
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