Comparison of pregnancy outcomes in women with repaired versus unrepaired atrial septal defect

BJOG. 2009 Nov;116(12):1593-601. doi: 10.1111/j.1471-0528.2009.02301.x. Epub 2009 Aug 13.


Objective: To compare the risks of complications during pregnancy in women with repaired and unrepaired atrial septal defects (ASDs) without associated complex cardiac lesions.

Design: A retrospective multicentre study.

Setting: Tertiary centres in the Netherlands and Belgium.

Population: Women with ASD without associated complex cardiac lesions.

Methods: Women were identified using two congenital heart disease registries. One hundred women were identified who had 243 pregnancies, including 49 miscarriages and six terminations of pregnancy. Detailed information on each completed pregnancy (n = 188; unrepaired ASD, n = 133; repaired ASD, n = 55) was obtained using medical records and telephone interviews. In addition, data from the Generation R database (a prospective cohort study; n = 9667) were used to determine the background risk (control group).

Main outcome measures: Adjusted odds ratios (AORs) for cardiac, obstetric and neonatal events controlled for multiple pregnancies per woman using general estimating equation analysis.

Results: Women with an unrepaired ASD had a higher risk of neonatal events (AOR = 2.99, 95% confidence interval [CI] 1.14-7.89, P = 0.027) than women with a repaired ASD. The risk of cardiac and obstetric complications was comparable between women with unrepaired and repaired ASDs. Compared with the general population, women with an unrepaired ASD had higher risks of pre-eclampsia (AOR = 3.54, 95% CI 1.26-9.98, P = 0.017), small-for-gestational-age births (AOR = 1.95, 95% CI 1.15-3.30, P = 0.013) and fetal mortality (AOR = 5.55, 95% CI 1.77-17.4, P = 0.003). By contrast, no differences were observed when comparing women with a repaired ASD versus controls.

Conclusions: Women with an unrepaired ASD are at increased risk of neonatal events in comparison with women with a repaired ASD. Compared with the general population, women with an unrepaired ASD are at increased risk of pre-eclampsia, small-for-gestational-age births and fetal mortality.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Arrhythmias, Cardiac / epidemiology
  • Arrhythmias, Cardiac / etiology
  • Belgium / epidemiology
  • Delivery, Obstetric / methods
  • Female
  • Fetal Death / epidemiology
  • Fetal Death / etiology
  • Heart Septal Defects, Atrial / epidemiology
  • Heart Septal Defects, Atrial / surgery*
  • Humans
  • Infant, Newborn
  • Infant, Small for Gestational Age
  • Maternal Age
  • Middle Aged
  • Netherlands / epidemiology
  • Pre-Eclampsia / epidemiology
  • Pre-Eclampsia / etiology
  • Pregnancy
  • Pregnancy Complications / epidemiology
  • Pregnancy Complications, Cardiovascular / epidemiology*
  • Pregnancy Outcome / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Young Adult