RESUMO
BACKGROUND: Pregnancy in women with a Fontan circulation is understood to have a significantly increased risk of maternal morbidity and mortality. Potential longer-term effects on health outcomes remain unknown. AIM: Ascertainment of adverse events, post-delivery, in women from the Australia and New Zealand (ANZ) Fontan Registry. Comparator data from women without pregnancy and men was utilised. METHODOLOGY/RESULTS: Living adults were identified (nâ¯=â¯263 women, 280 men) with Registry analysis ascertaining cardiac morphology, type of Fontan procedure, pregnancy and significant cardiac adverse events. Data are described descriptively for morphology and as median (inter quartile range) for other variables. Thirty women reported 45 pregnancies beyond 20â¯weeks' gestation. Despite being older, these women, pre-delivery, had the lowest cardiac morbidity burden, compared to both male and female controls (ORâ¯=â¯3.25 (95% CI 1.44-8.35, pâ¯=â¯0.008 and ORâ¯=â¯2.59 (95% CI 1.14-6.70), pâ¯=â¯0.03). These differences were not present post-delivery. Median follow-up time post-delivery was 3.6 (1.2-7.5) years. Thrombus documentation and thromboembolic events were more common post-delivery, although differences were not significant in a propensity analysis model (adjusting for post-Fontan follow-up time, age and type of Fontan). There were no differences in arrhythmia, cardioversion, heart transplant, Fontan conversion or mortality between women post-delivery and either male or female controls. CONCLUSION: The apparent increase in thromboembolic events post pregnancy requires further investigation in a larger group of women over a longer period of follow-up time. This may have potential implications for post-partum anticoagulation, and for future health outcomes.
Assuntos
Técnica de Fontan , Cardiopatias Congênitas , Complicações Cardiovasculares na Gravidez , Transtornos Puerperais , Tromboembolia , Adulto , Austrália/epidemiologia , Feminino , Técnica de Fontan/efeitos adversos , Técnica de Fontan/métodos , Técnica de Fontan/estatística & dados numéricos , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Nova Zelândia/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/epidemiologia , Transtornos Puerperais/etiologia , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Tromboembolia/diagnóstico , Tromboembolia/epidemiologia , Tromboembolia/etiologiaRESUMO
More women with congenital heart disease survive to childbearing ages, due to improvements in surgical practice and postoperative care. This review discusses pregnancy in women with a single ventricle, describing maternal obstetric and cardiovascular complications and the increased risks of prematurity and adverse neonatal outcomes. Recommendations are made based on current understanding, guidelines and published literature, with recognition that there is much knowledge yet to be gained.