Study note

Pregnancy in congenital heart disease

THE CONTEXT

Pregnancy increases circulatory demands, and its tolerance in congenital heart disease depends on the underlying condition.

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During pregnancy, plasma volume increases by 50%, whole blood volume by 40%, and cardiac output by a similar amount to whole blood volume.

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These changes may cause problems in women with congenital heart disease, although many with palliated or untreated disease tolerate pregnancy well.

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Obstructive lesions are poorly tolerated and are associated with significant maternal morbidity and mortality.

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Cyanotic conditions are especially poorly tolerated; specialised pre-conception counselling should explain the increased risks.

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Patients with surgically corrected disease often tolerate pregnancy well.

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Pregnancy is particularly hazardous with cyanosis or severe pulmonary hypertension; maternal mortality in Eisenmenger syndrome exceeds 50%.

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Among children of patients with congenital heart disease, 2%–5% are born with cardiac abnormalities, especially when the mother is affected.

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The risk may reach 20% in babies born to women with left-sided lesions.

NEETx

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