Pregnancy In Congenital Heart Disease: Risk Prediction And Counselling

Pregnancy is a major life event for almost every woman. However, for women with heart disease pregnancy is associated with additional risks and deserves special attention. The number of pregnancies in women with congenital heart disease has increased over the past decades and is expected to rise further in the coming years.1 Physiological changes in the cardiovascular system during pregnancy may bear a risk for those with congenital heart disease who are not able to sufficiently adapt.2 Subsequently, heart failure, arrhythmias and worsening of the cardiac condition may complicate pregnancy and expose mother and child to an increased risk of morbidity and mortality. Congenital heart disease is often already diagnosed and treated at the time women start thinking about pregnancy, and hence counselling and risk prediction can be offered. In contrast to acquired heart disease, congenital heart disease bears a relatively low risk of complications during pregnancy. This is partly attributable to good counselling and close follow-up in specialised centres. Dedicated guidelines on pregnancy and heart disease have become available in the past decade, enabling the physician to provide standard and individualised care during pregnancy.3 A multidisciplinary ‘pregnancy heart team’ is required to support management of counselling, follow-up and delivery. This review addresses risk stratification and counselling in women with congenital heart disease contemplating pregnancy.\n\n### Cardiovascular physiology during pregnancy\n\nPregnancy is associated with various physiological adaptions of the cardiovascular system.4–6 Cardiac output needs to increase up to 50% during pregnancy, to enable the fetal circulation, and this increase starts already during the first trimester. There is a 30%–40% decrease in vascular resistance. As part of the cardiac output, plasma volume expands in the first and second trimester, followed by an increase in heart rate of around 10%–20%. Delivery further pushes these changes to a temporary maximum. After delivery, large fluid shifts …