Table 1

Lesion-specific risks

Maternal cardiovascular riskObstetric risk (other than caesarean section)Fetal/Neonatal risk*References
ASD, repaired3.6% arrhythmia, 3.6% persistent NYHA deterioration11% hypertension/pre-eclampsia, 16% PPH1.8% offspring mortality†Yap BJOG 2009
ASD, unrepaired4.5% arrhythmia, 3% persistent NYHA deterioration, 0.8% TIA11% hypertension/pre-eclampsia, 8.3% PPH3.0% offspring mortalityYap BJOG 2009
VSD, repaired2.3% arrhythmia7% hypertension/pre-eclampsia, 12% PPH21% SGAYap BJOG 2010
VSD, unrepaired1% arrhythmia, 1% endocarditis15% hypertension/pre-eclampsia, 9.6% PPH6.7% SGA, 1% offspring mortalityYap BJOG 2010
AVSD23% persistent NYHA deterioration, 19% arrhythmias17% hypertension/pre-eclampsia, 6.3% gestational diabetes, 21% PPH10% SGA, 6.3% neonatal mortalityDrenthen EHJ 2005
TOF8%–12% arrhythmia or heart failure, 2% persistent NYHA deterioration8% hypertension/pre-eclampsia, 10% PPH17%–21% SGA, 18% prematurity, 6.5% offspring mortalityMeijer Heart 2005, Balci AHJ 2011, Kampman Us Obst Gyn 2017
Ebstein7.3% arrhythmia or heart failure8.5% PPH19%–27% prematurity, 18% offspring mortalityConnoly JACC 1994, Katsuragi AJObstGyn 2013, Lima Arch Cardiovasc Dis 2016
LVOT obstruction3.8%–12% heart failure, 2%–5.7% arrhythmia, 1% endocarditis6.4%–11% hypertension/pre-eclampsia, 4.2% PPH8%–21% prematurity, 13% SGA, 0%–1.1% fetal mortalitySilversides AJC 2003, Yap IJC 2008, Tzemos AHJ 2009, Orwat JACC 2016
RVOT obstruction9% heart failure15% hypertension-related complication17% prematurity, 4.8% offspring mortalityDrenthen Heart 2006, Greutmann EHJ 2010
TGA—after arterial switch0%–12% arrhythmia or heart failure9%–21% prematurityStoll JAMA card 2018, Tobler Am J Car 2010, Fricke Heart Lung Circ 2019, Horiuchi J Card 2019
TGA—after atrial repair6.6%–22% arrhythmia, 11%–14% persistent NYHA deterioration18% hypertension/pre-eclampsia, 14% PPH24%–38% prematurity, 22%–38% SGA, 12% offspring mortalityDrenthen EHJ 2005, Cataldo BJOG 2016, Trigas Circ J 2014
ccTGA26%–32% heart failure, CVA or worsening of cyanosis2% hypertension/pre-eclampsia, 14% PPH9% prematurity, 1.3% offspring mortalityTherrien Am J Card 1999, Gelson EJOG 2011, Drenthen JACC 2007
Fontan3%–37% arrhythmia, 4% thrombotic event, 3%–11% heart failure14% PPH59% prematurity, 20% SGA, 7.6%–17% offspring mortalityGarcia Ropero Circ CV Qual Outcomes 2018
Cyanotic disease32% heart failure, arrhythmia or progression of hypoxaemia10% PPH37% prematurity, up to 24% fetal mortalityLadouceur Circ 2017, Presbitero Circ 1994, Drenthen JACC 2007
(note: very broad spectrum of results)
0%–28% mortality, 31%–35% RV failure, 7% pulmonary hypertensive crisis, 7%–14% thromboembolism, 9% arrhythmia0%–6% pre-eclampsia, 0%–38% PPH17%–86% prematurity, 0%–7% offspring mortalityThomas JAHA 2017, Sliwa EJHF 2016, Bedard EHJ 2009
Eisenmenger36% mortality, 21%–45% heart failure, 19% thromboembolism29% PPH65%–88%% prematurity, 38%–83% SGA, 10%–27% fetal mortality, 18%–25% perinatal mortalityDrenthen JACC 2007, Duan BMC Pregnancy and Childbith 2016
CoarctationNone reported22% hypertension/pre-eclampsia2% offspring mortalityVriend EHJ 2005
  • This is a generalisation of lesions with very heterogenous patients, included in both prospective and retrospective studies. Specific characteristics such as ventricular dysfunction, valve stenosis or regurgitation, cyanosis and the presence of a mechanical valve may impact risks to a large extent. For detailed information, we recommend to evaluate the papers referred to in the last column. The full references are available in the online additional material (online supplementary file 2).

  • *SGA and prematurity only reported if >10%.

  • †Offspring mortality: late fetal death or neonatal death.

  • ‡Not reported.

  • ASD, atrial septal defect; AVSD, atrioventricular septal defect; ccTGA, congenitally corrected transposition of the great arteries; CHD, congenital heart disease; CVA, cerebrovascular accident; LVOT, left ventricular outflow tract; NYHA, New York Heart Association; PAH, pulmonary arterial hypertension; PDA, persistent ductus arteriosus; PPH, postpartum haemorrhage; RVOT, right ventricular outflow tract; SGA, small for gestational age; TGA, transposition of the great arteries; TIA, transient ischaemic attack; TOF, tetralogy of Fallot; VSD, ventricular septal defect.