Pregnant women with Uncorrected Congenital Heart Disease: Heart failure and mortality.

Globally, congenital heart disease (CHD) is an important cause of maternal morbidity and mortality in women reaching reproductive stage. There is lack of data from larger cohorts of women with uncorrected CHD. To study maternal and fetal outcome of women with uncorrected CHD. An analysis of 10-year data from the ESC EORP ROPAC Registry of women with uncorrected CHD. Of a total of 5739 pregnancies in 53 countries, 3295 women had CHD, with 1059 uncorrected. Of these, 41.4 % were from emerging countries. There were marked differences in cardiac defects in uncorrected versus corrected CHD with primary shunt lesions (44.7% vs 32.4%), valvular abnormalities (33.5% vs 12.6%) and Tetralogy of Fallot/Pulmonary atresia (0.8% vs 20.3%), p<0.001. In uncorrected CHD 6.8% were in mWHO risk class IV, about 10 % had pulmonary hypertension (PH) and 3% were cyanotic prior to pregnancy. Maternal mortality and heart failure (HF) in the women with uncorrected CHD was 0.7% and 8.7%. 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 threefold higher rate of hospital admissions for cardiac events and intrauterine growth retardation (p<0.001). We found marked differences in cardiac conditions in pregnant women with uncorrected CHD versus corrected CHD, with a markedly worse outcome, particularly in women with Eisenmenger syndrome and from emerging countries

Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

Aims: Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods: The European Society of Cardiology PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: 1) women without hypertension (‘PPCM-noHTN’); 2) women with hypertension but without pre-eclampsia (‘PPCM-HTN’); 3) women with pre-eclampsia (‘PPCM-PE’). Maternal (6-month) and neonatal outcomes were compared. Results: Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (NYHA IV in 44.4% and 29.9%, p<0.001), more frequent signs of heart failure (pulmonary rales in 70.7% and 55.4%, p=0.002), higher baseline LVEF (32.7% and 30.7%, p=0.005) and smaller left ventricular end diastolic diameter (57.4mm [±6.7] and 59.8mm [±8.1], p<0.001). There were no differences in the frequencies of death from any cause, re-hospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF≥50%) (adjusted OR 2.08 95% CI 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted OR 2.84 95% CI 1.66-4.87). Conclusion: Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM