There are many physiologic changes that have an effect on the cardiovascular system during pregnancy such as hemodynamic alterations, hypercoagulability, increased cardiac output and oxygen demand, vasodilation, etc. (Morton, 2021). As cardiovascular disease is one of the main indirect contributors to maternal mortality in developed countries, it is of utmost importance to explore how predisposing factors such as congenital heart defects (CHD) can impact the mother during pregnancy (Wander et al., 2023).

The percentage of pregnant women with CHD has been increasing since interventions such as surgery and medications have increased these patients’ prognoses. Even though they can live healthy lives, these patients have an increased risk of serious cardiac events during pregnancy, although it depends on the severity of the heart defect (Salciccioli & Cotts, 2021). Thus, pregnant women with CHD need special attention when it comes to monitoring their cardiovascular health to improve both maternal and fetal health. Therefore, the goal of this review is to discuss the appropriate approach for managing and preventing risk in pregnant women with congenital heart defects.

Findings

The most appropriate way to reduce or prevent any type of risk is to start working before conception, whenever possible, through preconception counseling. The American Heart Association (AHA) establishes a framework for the counseling of patients with CHD, which includes discussion of the potential risk of recurrence in children, individualized clinical status, medication adjustments, and risks during pregnancy, delivery, and postpartum (Stout et al., 2018). The AHA also emphasizes the importance of an adult congenital heart disease (ACHD) cardiologist being involved in the discussion for more accurate pregnancy risk assessment. Moreover, various predictive scales have been developed to assess maternal complications in CHD patient, aiming to reduce variability and improve case comparisons. Among these, the World Health Organization (WHO) scale appears to more accurately predict cardiovascular outcomes in pregnant women with CHD (Bredy et al., 2023).

During pregnancy, a better prognosis can be achieved with a multidisciplinary team composed of a cardiologist, obstetrician, anesthetist, specialist nurse, and midwife (Wander et al., 2023). Specific interventions and recommendations during pregnancy are individualized and vary according to the specific cardiologic profile of the patient and the outcomes presented by the fetus during ultrasounds. Wander et al. (2023) present the management and complications of each specific congenital heart defect in the study and serves as a valuable guide for physicians. Developing a detailed plan for delivery is recommended to improve both patient and fetal prognosis.

Conclusion

The management and risk prevention for pregnant women with CHD begins with preconception counseling. There is a need for a multidisciplinary approach to assess risk and develop an individualized plan according to the AHA guidelines. The end goal is to help guide individualized care plans to improve both maternal and fetal outcomes.

References

• Morton A. (2021). Physiological Changes and Cardiovascular Investigations in Pregnancy. Heart, lung & circulation, 30(1), e6–e15. https://doi.org/10.1016/j.hlc.2020.10.001
• Wander, G., van der Zande, J. A., Patel, R. R., Johnson, M. R., & Roos-Hesselink, J. (2023). Pregnancy in women with congenital heart disease: a focus on management and preventing the risk of complications. Expert review of cardiovascular therapy, 21(8), 587–599. https://doi.org/10.1080/14779072.2023.2237886
• Salciccioli, K. B., & Cotts, T. B. (2021). Pregnancy in Women with Adult Congenital Heart Disease. Cardiology clinics, 39(1), 55–65. https://doi.org/10.1016/j.ccl.2020.09.004
• Stout, K. K., Daniels, C. J., Aboulhosn, J. A., Bozkurt, B., Broberg, C. S., Colman, J. M., Crumb, S. R., Dearani, J. A., Fuller, S., Gurvitz, M., Khairy, P., Landzberg, M. J., Saidi, A., Valente, A. M., & Van Hare, G. F. (2019). 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 73(12), 1494–1563. https://doi.org/10.1016/j.jacc.2018.08.1028
• Bredy, C., Deville, F., Huguet, H., Picot, M. C., De La Villeon, G., Abassi, H., Avesani, M., Begue, L., Burlet, G., Boulot, P., Fuchs, F., & Amedro, P. (2023). Which risk score best predicts cardiovascular outcome in pregnant women with congenital heart disease?. European heart journal. Quality of care & clinical outcomes, 9(2), 177–183. https://doi.org/10.1093/ehjqcco/qcac019