Author + information
- Received June 26, 2019
- Revision received August 23, 2019
- Accepted September 4, 2019
- Published online September 13, 2019.
- Karen Sliwa, MD PhD1,2,
- Lucia Baris, MD3,
- Christoph Sinning, MD PhD4,
- Elvin Zengin-Sahm, MD PhD4,
- Lina Gumbiene, MD PhD5,
- Israa F. Yaseen, BPharm6,
- Ghada Youssef, MD7,
- Mark Johnson, MD PhD8,
- Hasan Al-Farhan, MD PhD6,
- Malgorzata Lelonek, MD PhD9,
- Roger Hall, MD PhD10 and
- Jolien Roos-Hesselink, MD PhD3,∗ ()
- 1Cardiovascular Research in Africa, Department of Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
- 2Mary McKillop Institute for Health Research, ACU, Melbourne, Australia
- 3Erasmus Medical Center, Rotterdam, The Netherlands
- 4University Medical Centre, Department of General and Interventional Cardiology, Hamburg, Germany
- 5Hatter Institute for Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- 6Baghdad Heart Center, Baghdad Teaching Hospital, Medical City, Baghdad, Iraq
- 7Cardiology Department, Kasr Al Ainy Hospitals, Faculty of Medicine, Cairo University, Cairo, Egypt
- 8Imperial College London, London, United Kingdom
- 9Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland
- 10Norfolk and Norwich University Hospitals, United Kingdom
- ↵∗Address for correspondence: Prof. Dr. Jolien W. Roos-Hesselink Erasmus MC Rotterdam P O Box 2040 Dr Molewaterplein 15 3015 GD Rotterdam, The Netherlands
Background Globally, congenital heart disease (CHD) is an important cause of maternal morbidity and mortality in women reaching reproductive stage. There is lack of data from larger cohorts of women with uncorrected CHD.
Objectives To study maternal and fetal outcome of women with uncorrected CHD.
Methods An analysis of 10-year data from the ESC EORP ROPAC Registry of women with uncorrected CHD.
Results Of a total of 5739 pregnancies in 53 countries, 3295 women had CHD, with 1059 uncorrected. Of these, 41.4 % were from emerging countries. There were marked differences in cardiac defects in uncorrected versus corrected CHD with primary shunt lesions (44.7% vs 32.4%), valvular abnormalities (33.5% vs 12.6%) and Tetralogy of Fallot/Pulmonary atresia (0.8% vs 20.3%), p<0.001. In uncorrected CHD 6.8% were in mWHO risk class IV, about 10 % had pulmonary hypertension (PH) and 3% were cyanotic prior to pregnancy. Maternal mortality and heart failure (HF) in the women with uncorrected CHD was 0.7% and 8.7%. 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 threefold higher rate of hospital admissions for cardiac events and intrauterine growth retardation (p<0.001).
Conclusions We found marked differences in cardiac conditions in pregnant women with uncorrected CHD versus corrected CHD, with a markedly worse outcome, particularly in women with Eisenmenger syndrome and from emerging countries.
- Uncorrected congenital heart disease
- emerging country
- pulmonary hypertension
10-year data from the ESC EORP Registry of Pregnancy And Cardiac disease (ROPAC)
All investigators listed in Appendix 1.
Since the start of EORP, the following companies have supported the programme: Abbott Vascular Int. (2011-2021), Amgen Cardiovascular (2009-2018), AstraZeneca (2014-2021), Bayer AG (2009-2018), Boehringer Ingelheim (2009-2019), Boston Scientific (2009-2012), The Bristol Myers Squibb and Pfizer Alliance (2011-2019), Daiichi Sankyo Europe GmbH (2011-2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (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), SERVIER (2009-20121).
DISCLOSURES: None of the authors have any relationship with Industry related to the content of this manuscript
- Received June 26, 2019.
- Revision received August 23, 2019.
- Accepted September 4, 2019.
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.