Ramage et al., 2019


To assess the association of ACHD and its subtypes with pregnancy, maternal, and neonatal outcomes.

2114 women with ACHD

Population-level administrative data from the Discharge

Abstract Database (DAD) in Canada

Cross-sectional retrospective design

In this large cross-sectional study of 2114 women with adult congenital heart disease in Canada, maternal and neonatal outcomes varied by subtype of maternal heart condition. Adult congenital heart disease was associated with increased odds of adverse maternal, neonatal, and pregnancy outcomes during labor and delivery hospitalization.

Cauldwell et al., 2016


Identify the factors associated with an increased post-partum blood loss in women with congenital heart disease (CHD).

366 nulliparous women with CHD

Chelsea and Westminster Hospital, UK

A retrospective study design

Women with CHD are at increased risk of post-partum hemorrhage (PPH).

Only women with a Fontan circulation were still significantly associated with higher blood loss at delivery.

Data support vaginal delivery as the default for women with cardiac disease. As it is associated with a lower risk of post-partum hemorrhage and a better fetal outcome.

Yadav et al., 2018


To study pregnancy outcomes in operated vs non-operated cases of congenital heart disease cases during pregnancy.

55 patients of CHD, 29 women had no cardiac surgery and 26 had cardiac surgery

Obstetric unit of a tertiary center unit, India

Retrospective study design

There was no difference in cardiac complications, NYHA deterioration and need of cardiac drugs in the two groups. Obstetric complications and mode of delivery were also similar in the two groups.

Birth weight was also similar in the both groups.

Stillbirth rate and other neonatal complications were also similar in two groups.

Gußmann et al., 2013


1) Assess functional class during and after pregnancy. 2) Analysis a self-assessment of health, work capability and physical activity during the longest recorded possible follow-up period.

N = 103


Heart Centre Berlin, Germany

Retrospective study. The long-term data were acquired with a self-assessment questionnaire from each patient

Evaluate the short-term and long-term follow-up in

simpler and more complex cardiac defects

The short-term outcome data for obstetric, maternal cardiac and neonatal complications. Outcome data on maternal cardiac complications indicated that two-thirds of the patients had no cardiovascular events. The main cardiac symptom was the loss of functional class before and in pregnancy. Prematurity and small sizes for gestational age were the main neonatal complications.

Two-thirds of the patients reported good outcomes in the self-assessments of health, work capability and physical activity in the long-term follow-up period. The health self-assessment correlated with physical activity.

For the long-term outcomes, 18% of the patients with contraindications died.

Only 25% of these patients answered the questionnaire.

All of these patients suffered from pulmonary hypertension.

Kamiya, et al., 2012


1) Characterize the risk factors for pregnancy-associated cardiac events, and 2) to evaluate the long-term effects of pregnancy on the heart in women with repaired TOF.

40 deliveries in 25 patients with repaired TOF

National Cerebral and

Cardiovascular Center, Japan

Retrospective descriptive study

Cardiac Events occurred in 7 of 40 deliveries (17.5%) in 7 patients (28%): 1 case of new onset of non-sustained ventricular tachycardia (NSVT) requiring treatment, 2 of heart failure, and 4 of worsening heart failure and arrhythmias including SVT and NSVT.

Obstetric Events: The mean week of delivery was shorter in patients with cardiac events than in those without cardiac events.

Offspring Events: There were no neonatal deaths. The mean birth weight was 2665 g and was significantly lower for offspring of patients with cardiac events.

The predictors of maternal cardiac events were a history of ablation for SVT and large CTR on chest radiograph.