title: Marfan syndrome and pregnancy: maternal and neonatal outcomes.
abstract: OBJECTIVE
  To report outcomes in a recent series of pregnancies in women with Marfan syndrome (MFS).
  
  
  METHODS
  Retrospective case note review.
  
  
  METHODS
  Tertiary referral unit (Chelsea and Westminster and Royal Brompton Hospitals).
  
  
  METHODS
  Twenty-nine pregnancies in 21 women with MFS between 1995 and 2010.
  
  
  METHODS
  Multidisciplinary review of case records.
  
  
  METHODS
  Maternal and neonatal mortality and morbidity of patients with MFS and healthy controls.
  
  
  RESULTS
  There were no maternal deaths. Significant cardiac complications occurred in five pregnancies (17%): one woman experienced a type-A aortic dissection; two women required cardiac surgery within 6 months of delivery; and a further two women developed impaired left ventricular function during the pregnancy. Women with MFS were also more likely to have obstetric complications (OR 3.29, 95% CI 1.30-8.34), the most frequent of which was postpartum haemorrhage (OR 8.46, 95% CI 2.52-28.38). There were no perinatal deaths, although babies born to mothers with MFS were delivered significantly earlier than those born to the control group (median 39 versus 40 weeks of gestation, Mann-Whitney U-test, P = 0.04). These babies were also significantly more likely to be small for gestational age (24% in the MFS group versus 6% in the controls; OR 4.95, 95% CI 1.58-15.55).
  
  
  CONCLUSIONS
  Pregnancy in women with MFS continues to be associated with significant rates of maternal, fetal, and neonatal complications. Effective pre-pregnancy counselling and meticulous surveillance during pregnancy, delivery, and the puerperium by an experienced multidisciplinary team are warranted for women with MFS.
authors.affiliation: Department of Maternal and Fetal Medicine, Institute for Women's Health, University College London, London, UK; Academic Department of Obstetrics and Gynaecology, Faculty of Medicine, Imperial College London, Chelsea and Westminster NHS Foundation Trust, London, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Curry
authors.forename: E
authors.initials: E
authors.lastname: Gelson
authors.forename: L
authors.initials: L
authors.lastname: Swan
authors.forename: D
authors.initials: D
authors.lastname: Dob
authors.forename: S V
authors.initials: SV
authors.lastname: Babu-Narayan
authors.forename: M A
authors.initials: MA
authors.lastname: Gatzoulis
authors.forename: P J
authors.initials: PJ
authors.lastname: Steer
authors.forename: M R
authors.initials: MR
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery; D001724:Birth Weight; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008382:Marfan Syndrome / Q000453:epidemiology*; D007744:Obstetric Labor Complications / Q000453:epidemiology; D009772:Obstetrical Forceps / Q000706:statistics & numerical data; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology; D055815:Young Adult
keywords: Marfan syndrome; pregnancy