Effect of pregnancy on clinical status and ventricular function in women with heart disease

Int J Cardiol. 2010 Feb 18;139(1):50-9. doi: 10.1016/j.ijcard.2008.09.001. Epub 2008 Oct 2.


Background: Pregnant women with heart disease (HD) are at an increased risk for maternal and neonatal adverse events. However, the effect of pregnancy on clinical status and ventricular function in women with HD has not been examined in a controlled study.

Methods and results: Ninety-three women with HD were studied longitudinally. Of these, fifty-three underwent clinical and echocardiographic evaluation before and 1.5+/-1.1 years after pregnancy (pregnancy group), whereas forty served as controls matched for age (28.6+/-4.6 versus 28.5+/-6.6, p=0.88), diagnosis, and length of follow-up (2.9+/-1.4 versus 2.6+/-1.1, p=0.23). NYHA functional class remained unchanged in both groups during follow-up. End diastolic and end systolic dimensions and shortening fraction of the morphologic left ventricle also remained unchanged. Furthermore, systemic and subpulmonary ventricular function remained unchanged in the pregnancy and control groups on semiquantitative analysis. Pregnancy, however, was associated with a persisting increase in subpulmonary ventricular size in patients with tetralogy of Fallot (ToF) which was not present in tetralogy controls. Furthermore, diagnosis of ToF was the only predictor of an increase in subpulmonary ventricular size after pregnancy on univariate logistic regression analysis (OR 8.8[95% CI 1.9-41.1], p=0.006).

Conclusions: In this longitudinal controlled study amongst women with HD no deleterious midterm effects of pregnancy on clinical status and right and left ventricular function were found. However, pregnancy was associated with a persisting increase in subpulmonary ventricular size, attributable to patients with repaired ToF. This may have prognostic implications and merits further investigation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cardiomegaly / diagnostic imaging
  • Cardiomegaly / physiopathology
  • Echocardiography
  • Female
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Mitral Valve Prolapse / diagnostic imaging
  • Mitral Valve Prolapse / physiopathology
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / diagnostic imaging
  • Pregnancy Complications, Cardiovascular / physiopathology*
  • Pregnancy Outcome*
  • Prognosis
  • Retrospective Studies
  • Tetralogy of Fallot / diagnostic imaging
  • Tetralogy of Fallot / physiopathology*
  • Transposition of Great Vessels / diagnostic imaging
  • Transposition of Great Vessels / physiopathology
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / physiopathology*
  • Ventricular Function, Left / physiology*
  • Young Adult