Maternal and fetal outcome in patients with cyanotic congenital heart disease: A multicenter observational study

Abstract

Maternal cyanotic congenital heart disease (CHD) is considered a great maternal and fetal risks during pregnancy, but information on management of these pregnancies are lacking. The purpose of this study was to assess maternal and fetal outcome in patients with cyanotic CHD in a large cohort of patients. This multicenter retrospective study included pregnant women with cyanotic CHD followed in 11 French specialized centers from 1997 to 2015. Patients with pulmonary hypertension were excluded. We recorded maternal, obstetrical and neonatal outcome. Thirty-one patients (mean age 27 ± 6 years) had 71 pregnancies. There were 17 (26%) miscarriages and 48 (73%) complete pregnancies (≥ 20 week gestation (WG)). All pregnancies were singleton. Severe cardiac events occurred in 7 patients (23%, 95% CI [10–41]) and 6 complete pregnancies (8%, 95% CI [3–17]). Heart failure ( n = 3) and arrhythmia ( n = 2) were the main cardiovascular complications. There was no maternal death. No thromboembolism event occurred, and one patient experienced an infective endocarditis during postpartum. Obstetrical complications included mainly hemorrhages ( n = 9, 13% of pregnancies). Small for gestational age (SGA) was diagnosed in 28%. The mean birth weight was 1897 ± 607 g at a mean gestational age of 33 ± 3WG, and 85% of newborns were premature. These two comorbidities were associated with an 11% neonatal mortality. Pre-pregnancy maternal oxygen saturation ≤ 85% was related to miscarriages and SGA ( P ≤ 0.04). Women with cyanotic CHD can go through pregnancy with a low risk for themselves. However, cyanotic CHD is associated with a high incidence of fetal and neonatal complications.