Table 1.
Lesion-specific risks
| Maternal cardiovascular risk | Obstetric risk (other than caesarean section) | Fetal/Neonatal risk* | References | |
| ASD, repaired | 3.6% arrhythmia, 3.6% persistent NYHA deterioration | 11% hypertension/pre-eclampsia, 16% PPH | 1.8% offspring mortality† | Yap BJOG 2009 |
| ASD, unrepaired | 4.5% arrhythmia, 3% persistent NYHA deterioration, 0.8% TIA | 11% hypertension/pre-eclampsia, 8.3% PPH | 3.0% offspring mortality | Yap BJOG 2009 |
| VSD, repaired | 2.3% arrhythmia | 7% hypertension/pre-eclampsia, 12% PPH | 21% SGA | Yap BJOG 2010 |
| VSD, unrepaired | 1% arrhythmia, 1% endocarditis | 15% hypertension/pre-eclampsia, 9.6% PPH | 6.7% SGA, 1% offspring mortality | Yap BJOG 2010 |
| PDA | ‡ | ‡ | ‡ | |
| AVSD | 23% persistent NYHA deterioration, 19% arrhythmias | 17% hypertension/pre-eclampsia, 6.3% gestational diabetes, 21% PPH | 10% SGA, 6.3% neonatal mortality | Drenthen EHJ 2005 |
| TOF | 8%–12% arrhythmia or heart failure, 2% persistent NYHA deterioration | 8% hypertension/pre-eclampsia, 10% PPH | 17%–21% SGA, 18% prematurity, 6.5% offspring mortality | Meijer Heart 2005, Balci AHJ 2011, Kampman Us Obst Gyn 2017 |
| Ebstein | 7.3% arrhythmia or heart failure | 8.5% PPH | 19%–27% prematurity, 18% offspring mortality | Connoly JACC 1994, Katsuragi AJObstGyn 2013, Lima Arch Cardiovasc Dis 2016 |
| LVOT obstruction | 3.8%–12% heart failure, 2%–5.7% arrhythmia, 1% endocarditis | 6.4%–11% hypertension/pre-eclampsia, 4.2% PPH | 8%–21% prematurity, 13% SGA, 0%–1.1% fetal mortality | Silversides AJC 2003, Yap IJC 2008, Tzemos AHJ 2009, Orwat JACC 2016 |
| RVOT obstruction | 9% heart failure | 15% hypertension-related complication | 17% prematurity, 4.8% offspring mortality | Drenthen Heart 2006, Greutmann EHJ 2010 |
| TGA—after arterial switch | 0%–12% arrhythmia or heart failure | ‡ | 9%–21% prematurity | Stoll JAMA card 2018, Tobler Am J Car 2010, Fricke Heart Lung Circ 2019, Horiuchi J Card 2019 |
| TGA—after atrial repair | 6.6%–22% arrhythmia, 11%–14% persistent NYHA deterioration | 18% hypertension/pre-eclampsia, 14% PPH | 24%–38% prematurity, 22%–38% SGA, 12% offspring mortality | Drenthen EHJ 2005, Cataldo BJOG 2016, Trigas Circ J 2014 |
| ccTGA | 26%–32% heart failure, CVA or worsening of cyanosis | 2% hypertension/pre-eclampsia, 14% PPH | 9% prematurity, 1.3% offspring mortality | Therrien Am J Card 1999, Gelson EJOG 2011, Drenthen JACC 2007 |
| Fontan | 3%–37% arrhythmia, 4% thrombotic event, 3%–11% heart failure | 14% PPH | 59% prematurity, 20% SGA, 7.6%–17% offspring mortality | Garcia Ropero Circ CV Qual Outcomes 2018 |
| Cyanotic disease | 32% heart failure, arrhythmia or progression of hypoxaemia | 10% PPH | 37% prematurity, up to 24% fetal mortality | Ladouceur Circ 2017, Presbitero Circ 1994, Drenthen JACC 2007 |
| PAH in CHD (note: very broad spectrum of results) |
0%–28% mortality, 31%–35% RV failure, 7% pulmonary hypertensive crisis, 7%–14% thromboembolism, 9% arrhythmia | 0%–6% pre-eclampsia, 0%–38% PPH | 17%–86% prematurity, 0%–7% offspring mortality | Thomas JAHA 2017, Sliwa EJHF 2016, Bedard EHJ 2009 |
| Eisenmenger | 36% mortality, 21%–45% heart failure, 19% thromboembolism | 29% PPH | 65%–88%% prematurity, 38%–83% SGA, 10%–27% fetal mortality, 18%–25% perinatal mortality | Drenthen JACC 2007, Duan BMC Pregnancy and Childbith 2016 |
| Coarctation | None reported | 22% hypertension/pre-eclampsia | 2% offspring mortality | Vriend EHJ 2005 |
This is a generalisation of lesions with very heterogenous patients, included in both prospective and retrospective studies. Specific characteristics such as ventricular dysfunction, valve stenosis or regurgitation, cyanosis and the presence of a mechanical valve may impact risks to a large extent. For detailed information, we recommend to evaluate the papers referred to in the last column. The full references are available in the online additional material (online supplementary file 2).
*SGA and prematurity only reported if >10%.
†Offspring mortality: late fetal death or neonatal death.
‡Not reported.
ASD, atrial septal defect; AVSD, atrioventricular septal defect; ccTGA, congenitally corrected transposition of the great arteries; CHD, congenital heart disease; CVA, cerebrovascular accident; LVOT, left ventricular outflow tract; NYHA, New York Heart Association; PAH, pulmonary arterial hypertension; PDA, persistent ductus arteriosus; PPH, postpartum haemorrhage; RVOT, right ventricular outflow tract; SGA, small for gestational age; TGA, transposition of the great arteries; TIA, transient ischaemic attack; TOF, tetralogy of Fallot; VSD, ventricular septal defect.