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Pregnancy in women with congenital heart defects: what are the risks?
  1. Toronto Congenital Cardiac Centre for Adults
  2. and The Prenatal Diagnosis Program
  3. The Toronto Hospital, University of Toronto
  4. 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada

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Increasing numbers of people with congenital heart defects (CHD) are surviving into adulthood as a result of advances in paediatric cardiology and cardiac surgery. As this patient group enters adulthood, reproductive issues and recurrence risks become a new and crucial focus for patients, partners, and caregivers.

Maternal and fetal risk

The pregnancy related changes in intravascular volume, cardiac output, and systemic vascular resistance may result in maternal or fetal deterioration in women with CHD. Pregnancy in women with CHD, not complicated by Eisenmenger syndrome, is associated with low mortality.1-3 However, they continue to be at risk for other cardiac complications such as arrhythmia, heart failure, or stroke. Poor maternal functional class, cyanosis, and the presence of significant aortic stenosis have been repeatedly mentioned as potential risk factors for maternal cardiac deterioration.1-5Maternal cyanosis is also a risk factor for fetal and neonatal complications.1-3 ,5 One recent study reported a 12% likelihood of a livebirth when the arterial oxygen saturation at rest was < 85%; the livebirth rate improved to 63% when the oxygen saturation was ⩾ 85%.5 In a recent study of 252 pregnancies in women with heart disease, the following independent predictors of cardiac events were identified3:

  • poor maternal functional class or cyanosis

  • history …

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