title: Risk of Pregnancy in Moderate and Severe Aortic Stenosis: From the Multinational ROPAC Registry.
abstract: Controversial results on maternal risk and fetal outcome have been reported in women with aortic stenosis (AS).
  
  
  
  The authors sought to investigate maternal and fetal outcomes in patients with AS in a large cohort.
  
  
  
  The Registry on Pregnancy and Cardiac Disease (ROPAC) is a global, prospective observational registry of women with structural heart disease, providing a uniquely large study population. Data of women with moderate (peak gradient 36 to 63 mm Hg) and severe AS (peak gradient ≥64 mm Hg) were analyzed.
  
  
  
  Of 2,966 pregnancies in ROPAC, the authors identified 96 women who had at least moderate AS (34 with severe AS). No deaths were observed during pregnancy and in the first week after delivery. However, 20.8% of women were hospitalized for cardiac reasons during pregnancy. This was significantly more common in severe AS compared with moderate AS (35.3% vs. 12.9%; p = 0.02), and reached the highest rate (42.1%) in severe, symptomatic AS. Pregnancy was complicated by heart failure in 6.7% of asymptomatic and 26.3% of symptomatic patients, but could be managed medically, except for 1 patient who was symptomatic before pregnancy and underwent balloon valvotomy. Children of patients with severe AS had a significantly higher percentage of low birth weight (35.0% vs. 6.0%; p = 0.006).
  
  
  
  Mortality in pregnant women with AS, including those with severe AS, appears to be close to zero in the current era. Symptomatic and severe AS does, however, carry a substantial risk of heart failure and is associated with high rates of hospitalization for cardiac reasons, although heart failure can nearly always be managed medically. The results highlight the importance of appropriate pre-conceptional patient evaluation and counseling.
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Orwat
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Gerhard-Paul
authors.initials: GP
authors.lastname: Diller
authors.affiliation: Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Iris M
authors.initials: IM
authors.lastname: van Hagen
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Schmidt
authors.affiliation: Adult Congenital Heart Disease Clinic, University Hospital, Basel, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tobler
authors.affiliation: Adult Congenital Heart Disease Program, University Heart Center, Zurich, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Greutmann
authors.affiliation: Department of Cardiology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Regina
authors.initials: R
authors.lastname: Jonkaitiene
authors.affiliation: Department of Cardiology, Benha University Hospital, Benha, Egypt.
authors.forename: Amro
authors.initials: A
authors.lastname: Elnagar
authors.affiliation: Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, United Kingdom.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Johnson
authors.affiliation: Department of Cardiology, Norwich Medical School, University of East Anglia, United Kingdom.
authors.forename: Roger
authors.initials: R
authors.lastname: Hall
authors.affiliation: Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands; EURObservational Research Programme, European Society of Cardiology.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
authors.affiliation: Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany. Electronic address: helmut.baumgartner@ukmuenster.de.
authors.forename: Helmut
authors.initials: H
authors.lastname: Baumgartner
mesh_terms: D000328:Adult; D001024:Aortic Valve Stenosis / Q000453:epidemiology*; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology; D006801:Humans; D038622:Internationality; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index
keywords: fetal outcome; heart failure; maternal outcome; risk factors