title: Cardiac adaption during pregnancy in women with congenital heart disease and healthy women.
abstract: Pregnancy in women with congenital heart disease (CHD) is associated with deterioration in cardiac function. However, longitudinal data are scarce. This study describes serial changes in cardiac dimensions and function during pregnancy in women with CHD and compares these with healthy pregnant women (controls).
  
  
  
  Eight tertiary centres prospectively enrolled 125 pregnant women with CHD (pregnancy duration <20 weeks). Controls (N=49) were recruited from low-risk midwife practices. Standardised echocardiography at 20 and 32 weeks gestation and 1 year postpartum was performed.
  
  
  
  Age and parity were comparable between both groups (p>0.1). Left ventricular ejection fraction (LVEF) <45% was present in 3.2% of women with CHD and 14.4% had tricuspid annular plane systolic excursion (TAPSE) <16 mm. Absolute values of ventricular function parameters and diameters were less favourable in women with CHD. No permanent changes occurred in right and left ventricular function parameters and dimensions in women with CHD. The patterns of change in cardiac function and dimensions were comparable between women with CHD and controls, except for LVEF (p=0.026). In women with right-sided CHD the pattern of TAPSE over time differed from controls (p=0.043) (no decrease in TAPSE postpregnancy in CHD). In women with left-sided CHD left ventricular end-diastolic diameter (LVEDD) tended to increase compared with controls (p=0.045).
  
  
  
  Absolute levels of ventricular function parameters and diameters differ between CHD and controls, but changes during and after pregnancy are generally comparable. However, different patterns over time seen for TAPSE and LVEDD in women with right-sided and left-sided CHD, respectively, compared with controls indicate the importance of echocardiographic follow-up during pregnancy in women with CHD.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.
authors.forename: Marlies A M
authors.initials: MA
authors.lastname: Kampman
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Mattia A E
authors.initials: MA
authors.lastname: Valente
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.affiliation: Department of Cardiology, Isala Clinic, Zwolle, The Netherlands.
authors.forename: Ali
authors.initials: A
authors.lastname: Balci
authors.affiliation: Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.affiliation: Department of Cardiology, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands.
authors.forename: A P J
authors.initials: AP
authors.lastname: van Dijk
authors.affiliation: Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Oudijk
authors.affiliation: Department of Cardiology, University Medical Center Leiden, University of Leiden, Leiden, The Netherlands.
authors.forename: M R M
authors.initials: MR
authors.lastname: Jongbloed
authors.affiliation: Department of Cardiology, University Medical Center 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 Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D009426:Netherlands; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016216:Ultrasonography, Prenatal / Q000379:methods; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right