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STATE-OF-THE-ART PAPER

Outcome of Pregnancy in Women With Congenital Heart Disease

A Literature Review

Willem Drenthen, MD^_*,_*, Petronella G. Pieper, MD, PhD^_*, Jolien W. Roos-Hesselink, MD, PhD, Willem A. van Lottum, MD^_*, Adriaan A. Voors, MD, PhD^_*, Barbara J.M. Mulder, MD, PhD, Arie P.J. van Dijk, MD, PhD^||, Hubert W. Vliegen, MD, PhD^¶, Sing C. Yap, MD, Philip Moons, PhD, RN^#, Tjark Ebels, MD, PhD, Dirk J. van Veldhuisen, MD, PhD, FACC^_*,1 on behalf of the ZAHARA Investigators

^_* Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
Department of Thoracic Surgery, University Medical Center Groningen, Groningen, the Netherlands
Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
^|| Department of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
^¶ Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
^# Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.

Manuscript received December 21, 2006; revised manuscript received February 27, 2007, accepted March 13, 2007.

^_* Reprint requests and correspondence: Dr. Willem Drenthen, Department of Cardiology, University Medical Centre Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, the Netherlands. (Email: w.drenthen{at}thorax.umcg.nl).

A search of peer-reviewed literature was conducted to identify reports that provide data on complications associated with pregnancy in women with structural congenital heart disease (CHD). This review describes the outcome of 2,491 pregnancies, including 377 miscarriages (15%) and 114 elective abortions (5%). Important cardiac complications were seen in 11% of the pregnancies. Obstetric complications do not appear to be more prevalent. In complex CHD, premature delivery rates are high, and more children are small for gestational age. The offspring mortality was high throughout the spectrum and was related to the relatively high rate of premature delivery and recurrence of CHD.

Abbreviations and Acronyms   AVSD = atrioventricular septal defect(s)   CHD = congenital heart disease   CoA = aortic coarctation   HELLP = hemolysis elevated liver enzymes low platelets   PAVSD = pulmonary atresia with ventricular septal defects   PS = pulmonary valve stenosis   SGA = small for gestational age   TGA = complete transposition of the great arteries   TOF = tetralogy of Fallot

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