European Heart Journal Advance Access originally published online on June 9, 2005
European Heart Journal 2005 26(20):2173-2178; doi:10.1093/eurheartj/ehi338
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Outcome of pregnancy in patients after repair of aortic coarctation
1Department of Cardiology, Academic Medical Center, Room B2-240, PO Box 22700, 1100 DE Amsterdam, The Netherlands
2Department of Cardiology, University Hospital, Groningen, The Netherlands
3Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
4Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
Received 23 December 2004; revised 28 March 2005; accepted 28 April 2005; online publish-ahead-of-print 9 June 2005.
* Corresponding author. Tel: +31 20 56 69 111; fax: +31 20 69 14 940. E-mail address: b.j.mulder{at}amc.uva.nl
Aims Nowadays, most women born with aortic coarctation reach childbearing age. However, data on outcome of pregnancy in women after repair of aortic coarctation are scarce. The aim of this study was to report on maternal and neonatal outcome of pregnancy in women after aortic coarctation repair.
Methods and results The CONCOR national registry on congenital heart disease in The Netherlands was reviewed for women of childbearing age (
18 years old) with a history of aortic coarctation repair. Medical history and maternal, obstetrical, and neonatal outcome were determined. Fifty-four of the 100 women included had a history of pregnancy. The 54 women had 126 pregnancies resulting in 98 successful pregnancies, 22 miscarriages, and six abortions. The success rate was estimated as 0.778 (SE 0.002) including abortions and 0.817 (SE 0.002) excluding abortions. There were 85 vaginal deliveries, seven vaginal deliveries with epidural analgesia, and six caesarean sections. There were two neonatal deaths. A total of 26 pregnancies were complicated by a hypertensive disorder of pregnancy. There were 21 pregnancies in 14 women complicated by hypertension and five pregnancies in four women complicated by pre-eclampsia. The hypertension- and pre-eclampsia-probabilities were estimated as 0.183 (SE 0.285) and 0.061 (SE 0.211), respectively. During pregnancy, five patients had an increase 15 mmHg across the site of repair at echocardiography, but only one patient required reintervention for recoarctation after delivery. Four of the 98 children (4%) had a congenital heart defect.
Conclusion Pregnancy is well tolerated in women after repair of aortic coarctation. However, an excess of miscarriages and hypertensive disorders of pregnancy were found.
Key Words: Coarctation • Pregnancy • Hypertension
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