title: Major adverse maternal cardiovascular-related events in those with aortopathies. What should we expect?
abstract: Major adverse maternal cardiovascular-related events (MAMCRE) in aortopathy patients undergoing pregnancy are poorly defined. The aim was to assess for MAMCRE in pregnant patients with aortopathy or aortic enlargement in conotruncal defects (CTD), and determine if there are differences between groups. We conducted a single-center retrospective review of pregnant women (2000-2013) with hereditary vascular disease (HVD: BAV, COA), heritable fibrillinopathies (HF: MFS, EDS, LDS, FTAAS), and CTD with aortic dilatation (TOF, d-TGA, DORV). MAMCRE included: aortic dissection/surgery, therapeutic abortion, change in mode of delivery, and aortic growth > 0.5 cm within 1 year. We identified 73 patients/97 pregnancies (39/50 HVD, 15/20 HF, and 19/27 CTD). There were 14 MAMCRE (14%); 85% (n = 12) occurred in HV and HF patients and was associated with higher baseline cross-sectional-to-height (CSA/Ht) ratio (6.6 [Symbol: see text] 2.5 vs. 5.1 [Symbol: see text] 1.3, p = 0.005). There was more aortic surgery in the HF (vs. HV) (RR 3.9, p = 0.12). Only 2 MAMCRE (aortic growth) occurred in CTD. Overall and emergent C-section was higher than the general population (52% vs. 29%, p < 0.001 and 16% vs. 3%, p < 0.001) as was postpartum hemorrhage (PPH) (6% vs. 1.5%, p < 0.001). We describe the largest series of pregnant women with aortopathy and found a substantial incidence of MAMCRE, which was associated with higher pre-pregnancy CSA/Ht ratio. Rates of C-section and PPH were higher than the general population. Our data suggest that larger, multi-center studies are needed to define risks that predict MAMCRE/obstetric events in women with aortopathies, allowing optimal medical care during pregnancy.
authors.affiliation: Nationwide Children's Hospital/The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA. Electronic address: elisa.bradley@nationwidechildrens.org.
authors.forename: Elisa A
authors.initials: EA
authors.lastname: Bradley
authors.affiliation: Nationwide Children's Hospital/The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Ali N
authors.initials: AN
authors.lastname: Zaidi
authors.affiliation: Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Goldsmith
authors.affiliation: Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Tracey
authors.initials: T
authors.lastname: Sisk
authors.affiliation: The Ohio State University, 410 W 10th Avenue, Columbus, OH 43210, USA.
authors.forename: David
authors.initials: D
authors.lastname: Colombo
authors.affiliation: Nationwide Children's Hospital/The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Roble
authors.affiliation: The Ohio State University, 410 W 10th Avenue, Columbus, OH 43210, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bradley
authors.affiliation: Nationwide Children's Hospital/The Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA.
authors.forename: Curt
authors.initials: C
authors.lastname: Daniels
mesh_terms: D000328:Adult; D001018:Aortic Diseases / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D009820:Ohio / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D012189:Retrospective Studies
keywords: Aortopathy; Maternal cardiovascular risk; Pregnancy