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Saxena et al. Vessel Plus 2022;6:15 Vessel Plus
DOI: 10.20517/2574-1209.2021.96

Review Open Access

Pregnancy with congenital heart disease

Anita Saxena, Jay Relan

Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India.
Correspondence to: Prof. Anita Saxena, Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New
Delhi 110029, India. E-mail: anitasaxena@hotmail.com

How to cite this article: Saxena A, Relan J. Pregnancy with congenital heart disease. Vessel Plus 2022;6:15.
https://dx.doi.org/10.20517/2574-1209.2021.96
Received: 5 Jul 2021 First Decision: 28 Jul 2021 Revised: 2 Aug 2021 Accepted: 17 Aug 2021 Published: 5 Mar 2022

Academic Editors: P. Syamasundar Rao, Alexander D. Verin Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Pregnancy is complicated by maternal cardiovascular disease in 1%-4% of cases. With advances in management of
congenital heart diseases (CHDs), the survival to adulthood and childbearing age is increasing all over the world.
The physiological adaptation during pregnancy adds to the hemodynamic burden of CHD, and, hence, many
women are diagnosed with CHD for the first time during pregnancy, more so in developing countries. The type of
underlying CHD and pre-pregnancy hemodynamics determine the risk of developing complications during
pregnancy. Hence, pre-pregnancy risk stratification and counseling are a crucial part of management plan. Some of
the serious CHDs are best treated in the preconception stage. The maximum chance of developing complications is
between 28 and 32 weeks of gestation, during labor, and up to two weeks after delivery. Common complications in
women with CHD during pregnancy and labor include heart failure, arrhythmias, bleeding/thrombosis, infective
endocarditis, and rarely maternal death. Fetal complications include abortion, stillbirth, prematurity, low birth
weight, and CHD. Comprehensive knowledge of these complications and their management is very important as an
experienced multidisciplinary team is critical for improving outcome of these patients. Special care is required for
pregnant women who have pulmonary hypertension, due to either Eisenmenger syndrome or other causes, severe
valve stenosis, aortopathy associated with bicuspid aortic valve/coarctation, or severe cyanotic CHDs. Most
women with CHD are at low risk, and successful pregnancy is feasible in the majority with optimal management.

Keywords: Adult congenital heart disease, maternal cardiac disease, maternal mortality, maternal morbidity, risk
stratification, pregnancy complications

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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