Pregnancy in congenital cardiac disease: an increasing challenge for cardiologists and obstetricians: a prospective multicenter study

• Published in: Clinical research in cardiology 2003, Vol.92 (1), p.16-23
• Main Authors: KAEMMERER, H, BAUER, U, LANGE, P. E, BEITZKE, A, SCHNEIDER, K. T. M, HESS, J, STEIN, J.-I, LEMP, S, BARTMUS, D, HOFFMANN, A, NIESERT, S, OSMERS, R, FRATZ, S, ROSSA, S
• Format: Article
• Language: English
• Subjects: Abortion; Adolescent; Adult; Biological and medical sciences; Bleeding; Cause of Death; Cesarean Section; Combined Modality Therapy; Complications; Coronary artery disease; Cyanosis; Diseases of mother, fetus and pregnancy; Endocarditis; Extraction, Obstetrical; Female; Fetal Death - epidemiology; Germany; Gynecology. Andrology. Obstetrics; Heart Defects, Congenital - mortality; Heart Defects, Congenital - therapy; Heart diseases; Heart surgery; Humans; Hypertension; Infant, Newborn; Medical sciences; Neonatal Screening; Obstetric Labor Complications - mortality; Obstetric Labor Complications - therapy; Patient Care Team; Physicians; Population studies; Pregnancy; Pregnancy complications; Pregnancy Complications, Cardiovascular - mortality; Pregnancy Complications, Cardiovascular - therapy; Pregnancy Outcome; Pregnancy. Fetus. Placenta; Premature birth; Prospective Studies; Puerperal Disorders - mortality; Puerperal Disorders - therapy; Puerperium; Survival Analysis
• ISSN: 0300-5860; 1861-0684; 1435-1285; 1861-0692
• DOI: 10.1007/s00392-003-0880-0

Aim of this study was to assess the occurrence of pregnancy-related complications of mother and child during pregnancy, delivery and puerperium in women with CCD prospectively. STUDY DESIGN, POPULATION: This prospective multicenter study included 122 pregnancies in 106 women with CCD (72 with, 34 without previous cardiac surgery). Patient age was 17-44, median 26 years. Cardiac and non-cardiac complications, mode of delivery, abortion, and CCD of the newborn were assessed. Initially all women were in Functional Class I or II. Worsening during pregnancy occurred in 25.5% (n=27), mainly during the second and third trimester. Significant problems due to bleeding, hypertension, rhythm disturbances, endocarditis, liver congestion, increasing cyanosis or death, occurred in 11.3%. Twelve per cent of deliveries were premature. Five women had therapeutic abortion, nine spontaneous abortions, nine preterm births, and one intrauterine death. Seventy-nine per cent (n=85) delivered spontaneously; 21.3% (n=23) had caesarean section. Of the 111 live born children, 5.4% (n=6) had a CCD. Most women with CCD and a good functional class before pregnancy tolerate pregnancy without major problems. However, pregnancy may induce serious cardiac and obstetric complications. The specific risks require an individualized multidisciplinary patient-management by experienced physicians.