Format

Send to

Choose Destination
See comment in PubMed Commons below
Int J Cardiol. 2015;187:84-9. doi: 10.1016/j.ijcard.2015.03.344. Epub 2015 Mar 23.

Maternal and fetal outcomes of pregnancy with Fontan circulation: A multicentric observational study.

Author information

1
Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C Paris, France; Adult Congenital Heart Disease Unit, Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France.
2
Service de Gynécologie Obstétrique, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Universités, UPMC Univ Paris 06, CNRS UMR 7222, INSERM U1150-, Paris, France.
3
Baylor College of Medicine, Houston, TX, USA.
4
Cardiologie Pédiatrique et Congénitale Adulte, Hôpital Cardiovasculaire Louis Pradel, Lyon, France.
5
Pediatric Department, Clinique Saint Augustin, Bordeaux, France.
6
Cardiologie Congénitale, Strasbourg, France.
7
Pediatric Cardiology Department, Hôpital Nord, Amiens, France.
8
Pediatric Department 1, Hôpital Arnaud de Villeneuve, Montpellier, France.
9
Pediatric Department 1, Centre Hospitalo-Universitaire de Rouen, Rouen, France.
10
Department of Cardiology, CHU de Caen, Avenue Côte-de-Nacre, Caen, France.
11
Maladies Cardiovasculaires Infantiles et Congénitales, Lille, France.
12
Pediatric Department, Hôpital Clocheville, Tours, France.
13
Cardiologie Congénitale Adulte et Pédiatrique, Hôpital Mère-enfant-maternité, Nantes, France.
14
Centre de Référence des Malformations Cardiaques Congénitales Complexes, M3C Paris, France; Adult Congenital Heart Disease Unit, Department of Cardiology, Hôpital Européen Georges Pompidou and Necker Hospital, APHP, Paris Descartes Universités, Paris Centre de Recherche Cradiovasculaire, INSERM U970, Paris, France. Electronic address: magalie.ladouceur@egp.aphp.fr.

Abstract

BACKGROUND:

Despite serious long-term sequel, women with Fontan palliation have reached childbearing age. However there is paucity of data on the pregnancy outcomes and management of this condition. We aimed to determine the maternal and fetal outcomes of pregnancy in women with Fontan palliation.

METHODS:

This multicentric, retrospective study included women with Fontan circulation followed in 13 French specialized centers from January 2000 to June 2014. All pregnancies were reviewed, including miscarriages, abortions, premature and term births. We reviewed maternal and fetal outcomes.

RESULTS:

Thirty-seven patients had 59 pregnancies. Mean age was 27 ± 5 years at first pregnancy. There were 16 miscarriages (27%) and 36 live births with 1 twin pregnancy. Cardiac events occurred in 6 (10%) pregnancies, with no maternal death. The most common cardiac complication was atrial arrhythmia, which occurred in 3 patients. Hematological complications including thromboembolic/hemorrhagic events (n=3/7) occurred in 5 women antepartum (n=2/3), and 4 women postpartum (n=1/4). Two of the 3 thromboembolic events occurred in patients without anticoagulation. There was a high incidence of prematurity (n=25/36, 69%). Anticoagulation was associated with adverse neonatal outcome (OR=10.0, 95% CI [1.5-91.4], p<0.01). After a median follow-up of 24 months, there was no significant worsening of clinical status and thromboembolic disease noted.

CONCLUSIONS:

Pre-selected women can successfully complete pregnancy with Fontan circulation. There is an increase in cardiac and neonatal morbidity during pregnancy. Because thromboembolism could have a severe consequence on Fontan circulation, anticoagulation should be indicated during pregnancy and postpartum period.

KEYWORDS:

Anticoagulation; Congenital heart disease; Fontan circulation; Pregnancy

PMID:
25828319
DOI:
10.1016/j.ijcard.2015.03.344
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Support Center