Siegmund, A.S. (2015) Pregnancy in women with corrected aortic coarctation: uteroplacental Doppler flow parametersand pregnancy outcome. thesis, Medicine.
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Abstract
Background: Coarctation of the aorta (CoA) is a stenosis of the proximal thoracic descending aorta and accounts for 6–8% of the congenital heart defects. Women with repaired CoA are now expected to reach childbearing age. In these women, risk of pregnancy related complications is mild to moderately increased, with hypertensive disorders of pregnancy as a common complication. In healthy pregnant women with poor placentation, an increased prevalence of cardiac dysfunction was found. Poor placentation is reflected by uteroplacental Doppler flow (UDF) abnormalities and is previously reported in women with congenital heart disease (CHD). In these women with CHD, impaired uteroplacental Doppler flow was related to maternal cardiac function and obstetric and offspring complications. In women with aortic coarctation, UDF patterns during pregnancy have never been described. The aim of this study is to compare UDF parameters and pregnancy outcome in CoA women with healthy women and relate cardiac function to UDF. Methods: This prospective cohort study comprised all pregnant women with aortic coarctation and healthy pregnant women included in the ZAHARA II and ZAHARA III study (Zwangerschap bij Aangeboren HARtAfwijkingen, pregnancy in congenital heart disease). Clinical evaluation, laboratory results, echocardiographic and UDF parameters at 20 and 32 weeks of gestation, and pregnancy outcome were compared between 49 CoA and 69 healthy women. Univariate linear regression was used to assess associations between UDF parameters and cardiac function parameters preconception and at 20 weeks of gestation. Results: No difference was found in UDF parameters between CoA women and healthy women. Women with CoA experienced more cardiovascular complications (10.9% vs. 0%, P=0.009), mainly NYHA class deterioration ≥2 points. No differences were found in incidence of obstetric and offspring events between CoA women and healthy women. Offspring of CoA women had lower birth weight (P=0.001) and APGAR scores (P<0.040) than offspring of healthy women. Cardiovascular parameters (N-terminal pro-B-type natriuretic peptide, left and right ventricular function and aortic diameters) differed between both groups. Left and right ventricular function parameters preconception and at 20 weeks of gestation were associated with impaired uteroplacental flow. UDF parameters were related to offspring complications. Conclusion: Overall, women with corrected aortic coarctation tolerate pregnancy well. They have no higher risk of defect placentation or adverse pregnancy outcome than healthy pregnant women. Though acute aortic complications during pregnancy are scarce, pregnant women with CoA should be monitored closely since progressive aortic dilatation can occur. Although there is no difference in uteroplacental Doppler flow parameters between the overall population of women with CoA and healthy women, we have found a relation between both left and right ventricular function and impaired uteroplacental flow. This may imply that in a few women with CoA who have impaired left or right ventricular function, placental development may be negatively affected.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Pieper, P.G. MD and Kampman, M.A.M. MD and Research institution: University Medical Center Groningen (U and Research department: Department of Cardiology |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1388 |
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