title: Uteroplacental blood flow, cardiac function, and pregnancy outcome in women with congenital heart disease.
abstract: BACKGROUND
  Pregnant women with congenital heart disease (CHD) are susceptible to cardiovascular, obstetric, and offspring complications. In women with CHD, cardiac dysfunction may compromise uteroplacental flow and contribute to the increased incidence of obstetric and offspring events.
  
  
  RESULTS
  We performed a prospective multicenter cohort study of pregnant women with CHD and healthy pregnant women. We compared clinical, laboratory, echocardiographic, and uteroplacental Doppler flow (UDF) parameters at 20 and 32 weeks gestation, and pregnancy outcome. We related cardiovascular parameters to UDF parameters and pregnancy outcome in women with CHD. We included 209 women with CHD and 70 healthy women. Cardiovascular parameters (N-terminal pro-B-type natriuretic peptide, left and right ventricular function) differed between both groups. UDF parameters were impaired in CHD women (umbilical artery pulsatility and resistance index at 32 weeks in CHD versus healthy women, P=0.0085 and P=0.017). The following cardiovascular parameters prepregnancy and at 20 weeks gestation were associated with UDF (umbilical artery resistance index) at 32 weeks at multivariable analysis: (1) right ventricular function (tricuspid annular plane systolic excursion) (P=0.002), (2) high N-terminal pro-B-type natriuretic peptide (P=0.085), (3) systemic (P=0.001), and (4) pulmonary (P=0.045) atrioventricular valve regurgitation. Women with CHD had more obstetric (58.9% versus 32.9%, P<0.0001) and offspring events (35.4% versus 18.6%, P=0.008) than healthy women. Impaired UDF was associated with adverse obstetric and offspring outcome.
  
  
  CONCLUSIONS
  UDF parameters are abnormal in pregnant women with CHD. Cardiovascular function is associated with an abnormal pattern of UDF. Compromised UDF may be a key factor in the high incidence of offspring and obstetric complications in this population.
authors.affiliation: Departments of Cardiology (P.G.P., A.B., M.A.M.K., W.D., D.J.v.V.), Obstetrics (J.G.A., K.M.S.), and Epidemiology (H.G.), University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands (A.B., M.A.M.K.); Department of Cardiology, Isala, Zwolle, The Netherlands (A.B.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (B.J.M.M.); Department of Obstetrics, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands (M.A.O.); Departments of Cardiology (J.W.R.-H.) and Obstetrics (J.C.), Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands; and Departments of Cardiology (A.P.J.v.D.) and Obstetrics (M.E.S.), Radboud University Nijmegen Medical Centre, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
authors.forename: Ali
authors.initials: A
authors.lastname: Balci
authors.forename: Jan G
authors.initials: JG
authors.lastname: Aarnoudse
authors.forename: Marlies A M
authors.initials: MA
authors.lastname: Kampman
authors.forename: Krystyna M
authors.initials: KM
authors.lastname: Sollie
authors.forename: Henk
authors.initials: H
authors.lastname: Groen
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Oudijk
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.forename: Jerome
authors.initials: J
authors.lastname: Cornette
authors.forename: Arie P J
authors.initials: AP
authors.lastname: van Dijk
authors.forename: Marc E
authors.initials: ME
authors.lastname: Spaanderman
authors.forename: Willem
authors.initials: W
authors.lastname: Drenthen
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity / Q000502:physiology*; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D021041:Placental Circulation / Q000502:physiology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D011446:Prospective Studies; D055815:Young Adult
keywords: complications; congenital; heart diseases; placental circulation; pregnancy