Author + information
- Received June 26, 2019
- Revision received August 23, 2019
- Accepted September 4, 2019
- Published online January 27, 2020.
- Karen Sliwa, MD, PhDa,b,
- Lucia Baris, MDc,
- Christoph Sinning, MD, PhDd,
- Elvin Zengin-Sahm, MD, PhDd,
- Lina Gumbiene, MD, PhDe,
- Israa F. Yaseen, BPharmf,
- Ghada Youssef, MDg,
- Mark Johnson, MD, PhDh,
- Hasan Al-Farhan, MD, PhDf,
- Malgorzata Lelonek, MD, PhDi,
- Roger Hall, MD, PhDj and
- Jolien Roos-Hesselink, MD, PhDc,∗ ()
- aDepartment of Cardiology and Medicine, Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- bMary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- cErasmus Medical Center, Rotterdam, the Netherlands
- dDepartment of General and Interventional Cardiology, University Medical Centre, Hamburg, Germany
- eClinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- fBaghdad Heart Center, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq
- gCardiology Department, Kasr Al Ainy Hospitals, Faculty of Medicine, Cairo University, Cairo, Egypt
- hImperial College London, London, United Kingdom
- iDepartment of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland
- jNorfolk and Norwich University Hospitals, Norwich, United Kingdom
- ↵∗Address for correspondence:
Prof. Dr. Jolien W. Roos-Hesselink, Erasmus MC Rotterdam, PO Box 2040, Dr. Molewaterplein 15, 3015 GD Rotterdam, the Netherlands.
Objectives The purpose of this work was to study maternal and fetal outcomes of women with uncorrected congenital heart disease (CHD).
Background Globally, CHD is an important cause of maternal morbidity and mortality in women reaching reproductive stage. Data are lacking from larger cohorts of women with uncorrected CHD.
Methods The 10-year data from the European Society of Cardiology EORP ROPAC (EURObservational Research Programme Registry of Pregnancy and Cardiac disease) registry of women with uncorrected CHD were analyzed.
Results Of 5,739 pregnancies in 53 countries, 3,295 women had CHD, 1,059 of which were uncorrected cases. Of these, 41.4% were from emerging countries. There were marked differences between the cardiac defects in uncorrected cases versus those in corrected CHD cases with primary shunt lesions (44.7% vs. 32.4%, respectively), valvular abnormalities (33.5% vs. 12.6%, respectively), and Tetralogy of Fallot and pulmonary atresia (0.8% vs. 20.3%, respectively; p < 0.001). In patients with uncorrected CHD, 6.8% were in modified World Health Organization risk class IV, approximately 10% had pulmonary hypertension (PH), and 3% were cyanotic prior to pregnancy. Maternal mortality and heart failure (HF) in the women with uncorrected CHD were 0.7% and 8.7%, respectively. Eisenmenger syndrome was associated with a very high risk of cardiac events (65.5%), maternal mortality (10.3%), and HF (48.3%). Coming from an emerging country was associated with higher pre-pregnancy signs of HF, PH, and cyanosis (p < 0.001) and worse maternal and fetal outcomes, with a 3-fold higher rate of hospital admissions for cardiac events and intrauterine growth retardation (p < 0.001).
Conclusions Marked differences between cardiac conditions in pregnant women with uncorrected CHD and those in corrected CHD were found, with a markedly worse outcome, particularly in women with Eisenmenger syndrome and from emerging countries.
Since the start of the European Society of Cardiology EORP ROPAC program, the following companies have supported the programme: Abbott Vascular International (2011-2021), Amgen Cardiovascular (2009-2018), AstraZeneca (2014-2021), Bayer AG (2009-2018), Boehringer Ingelheim (2009-2019), Boston Scientific (2009-2012), Bristol-Myers Squibb and Pfizer Alliance (2011-2019), Daiichi Sankyo Europe GmbH (2011-2020), Daiichi Sankyo Europe GmbH and Eli Lilly and Company Alliance (2014-2017), Edwards (2016-2019), Gedeon Richter Plc. (2014-2016), Menarini Int. Op. (2009-2012), MSD-Merck & Co. (2011-2014), Novartis Pharma AG (2014-2020), ResMed (2014-2016), Sanofi (2009-2011), and Servier (2009-2012). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 26, 2019.
- Revision received August 23, 2019.
- Accepted September 4, 2019.
- 2020 American College of Cardiology Foundation
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