@article {185808, title = {Pregnant Women With Uncorrected Congenital Heart Disease: Heart~Failure and Mortality.}, journal = {JACC. Heart failure}, volume = {8}, year = {2020}, pages = {100-110}, abstract = {

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.

}, author = {Sliwa, Karen and Baris, Lucia and Sinning, Christoph and Zengin-Sahm, Elvin and Gumbiene, Lina and Yaseen, Israa F and Ghada Youssef and Johnson, Mark and Al-Farhan, Hasan and Malgorzata Lelonek, and Roger Hall and Roos-Hesselink, Jolien} }