title: Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease.
abstract: OBJECTIVE
  Adequate prepregnancy prediction of maternal cardiovascular and offspring risk is important for counselling and management of pregnancy in women with congenital heart disease (CHD). Therefore we performed a study to identify the optimal assessment strategy for estimating the risk of pregnancy in women with CHD.
  
  
  METHODS
  In this prospective study, we determined the outcomes of 213 pregnancies in 203 women with CHD. The ZAHARA I (Zwangerschap bij Aangeboren HARtAfwijkingen I) and CARPREG (CARdiac disease in PREGnancy) risk scores were calculated for each pregnancy, as was the total number of cardiovascular (TPc) or offspring risk predictors (TPo) from these and other studies combined. Pregnancies were also classified according to the modified WHO classification of maternal cardiovascular risk and according to disease complexity (DC).
  
  
  RESULTS
  Maternal cardiovascular events occurred during 22 pregnancies (10.3%). Offspring events occurred during 77 pregnancies in 81 children (37.3%). Cardiovascular and offspring event rates increased with higher risk scores, higher TPc or TPo, higher WHO class and greater DC. The highest area under the curve (AUC) for maternal cardiovascular risk was achieved by the WHO class (AUC: 0.77, p<0.0001). AUC for the ZAHARA I risk score was 0.71 (p=0.001), and for the CARPREG risk score 0.57 (p=0.32). All models performed insufficiently in predicting offspring events (AUC≤0.6).
  
  
  CONCLUSIONS
  The WHO classification is the best available risk assessment model for estimating cardiovascular risk in pregnant women with CHD. None of the offspring prediction models perform adequately in our cohort.
authors.affiliation: Department of Cardiology, Isala, Zwolle, The Netherlands Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Ali
authors.initials: A
authors.lastname: Balci
authors.affiliation: Department of Obstetrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Krystyna M
authors.initials: KM
authors.lastname: Sollie-Szarynska
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Antoinette G L
authors.initials: AG
authors.lastname: van der Bijl
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Titia P E
authors.initials: TP
authors.lastname: Ruys
authors.affiliation: Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Department of Cardiology, Radboud University Nijmegen Medical Centre, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors.forename: Arie P J
authors.initials: AP
authors.lastname: van Dijk
authors.affiliation: Department of Cardiology, Medical Spectrum Twente, Enschede, The Netherlands.
authors.forename: Elly M C J
authors.initials: EM
authors.lastname: Wajon
authors.affiliation: Department of Cardiology, Leiden University Medical Centre, University of Leiden, Leiden, The Netherlands.
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Drenthen
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.affiliation: Department of Cardiology, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Jan G
authors.initials: JG
authors.lastname: Aarnoudse
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
mesh_terms: D019540:Area Under Curve; D003661:Decision Support Techniques; D005260:Female; D005313:Fetal Death; D005858:Germany; D006330:Heart Defects, Congenital / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008428:Maternal Mortality; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors
keywords: Congenital Heart Disease