title: Associations between cardiovascular parameters and uteroplacental Doppler (blood) flow patterns during pregnancy in women with congenital heart disease: Rationale and design of the Zwangerschap bij Aangeboren Hartafwijking (ZAHARA) II study.
abstract: BACKGROUND
  Previous research has shown that women with congenital heart disease (CHD) are more susceptible to cardiovascular, obstetric, and offspring events. The causative pathophysiologic mechanisms are incompletely understood. Inadequate uteroplacental circulation is an important denominator in adverse obstetric events and offspring outcome. The relation between cardiac function and uteroplacental perfusion has not been investigated in women with CHD. Moreover, the effects of physiologic changes on pregnancy-related events are unknown. In addition, long-term effects of pregnancy on cardiac function and exercise capacity are scarce.
  
  
  METHODS
  Zwangerschap bij Aangeboren Hartafwijking (ZAHARA) II, a prospective multicenter cohort study, investigates changes in and relations between cardiovascular parameters and uteroplacental Doppler flow patterns during pregnancy in women with CHD compared to matched healthy controls. The relation between cardiovascular parameters and uteroplacental Doppler flow patterns and the occurrence of cardiac, obstetric, and offspring events will be investigated. At 20 and 32 weeks of gestation, clinical, neurohumoral, and echocardiographic evaluation and fetal growth together with Doppler flow measurements in fetal and maternal circulation are performed. Maternal evaluation is repeated 1 year postpartum.
  
  
  CONCLUSIONS
  By identifying the factors responsible for pregnancy-related events in women with CHD, risk stratification can be refined, which may lead to better pre-pregnancy counseling and eventually improve treatment of these women.
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Ali
authors.initials: A
authors.lastname: Balci
authors.forename: Krystyna M
authors.initials: KM
authors.lastname: Sollie
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.forename: Monique W M
authors.initials: MW
authors.lastname: de Laat
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.forename: Arie P J
authors.initials: AP
authors.lastname: van Dijk
authors.forename: Elly M C J
authors.initials: EM
authors.lastname: Wajon
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.forename: Willem
authors.initials: W
authors.lastname: Drenthen
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Jan G
authors.initials: JG
authors.lastname: Aarnoudse
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
mesh_terms: D035843:Biomedical Research / Q000379:methods; D005260:Female; D006331:Heart Diseases / Q000151:congenital* / Q000503:physiopathology*; D006801:Humans; D015337:Multicenter Studies as Topic; D010920:Placenta / Q000098:blood supply*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000503:physiopathology*; D011446:Prospective Studies; D012039:Regional Blood Flow; D018608:Ultrasonography, Doppler; D014599:Uterus / Q000098:blood supply*