Maternal and foetal outcomes in pregnancies from women with congenital heart disease (ACHD)

Objective. Pregnancies in adult congenital heart defects (ACHD-ESC guidelines) are susceptible of cardiovascular and obstetrical complications. Cardiac dysfunction may compro­mise utero-placental flow and contribute to impair obstetrical and neonatal outcome. The aim of this study was to evalu­ate maternal and neonatal outcomes in ACHD according to mWHO classes.
Materials and Methods. This is a retrospective study of preg­nancies in ACHD followed at ASST Papa Giovanni XXIII, Bergamo from 2016 to 2023. Data on cardiac, maternal, obstet­rical and neonatal outcomes were collected and categorized according to mWHO class. Neonatal and maternal outcomes were analysed by Fisher test. A P-value < 0.05 was considered statistically significant.
Results. 49 pregnancies were included. Mean maternal age at delivery was 30 (19-43). 7 (14.3%), 12 (24.5%), 19 (38.8%) and 11 (22.4%) women were included in I, II, II-III and III mWHO classes, respectively. A-V septal defects (7; 14.3%), tetralogy of Fallot (9; 18.4%), and moderate aortic stenosis (7; 14.3%) were the most represented. Mean gestational age at delivery was 37+6 weeks (30-41). 49% underwent caesarean section (CS), 58% of these for cardiac indication. 16.3% were complicated by FGR. 6 patients showed a clinical worsening after delivery (12.5%), 2 requiring admission to intensive care unit. There were no maternal deaths. Comparing outcomes according to mWHO classes, class III pregnancies showed a significantly higher risk of iatrogenic preterm birth (p = 0.02), elective CS (p = 0.07), hypertensive complications (p = 0.05) and neonatal respiratory distress (p = 0.03) when compared to other classes.
Conclusions. Pregnancy complications in women with CHD are frequent, particularly in higher mWHO classes. In ACHD, pregnancy should be accurately planned and a multidisci­plinary counselling should be offered.