Dr Emily Moroney1, Ms Carley Clendenning2, Ms Diana Zannino2, Professor Gruschen Veldtman3, Associate Professor Rachael Cordina4,5, Associate Professor Dominica Zentner2,6,7
1St Vincents Hospital, Melbourne, Australia, 2Murdoch Children's Research Institute, Parkville, 3052, 3Scottish Adult Congenital Cardiac Service, Glasgow, United Kingdom, 4Department of Cardiology, Royal Prince Alfred Hospital, Newtown, Australia, 5Sydney Medical School, Camperdown, Australia, 6Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia, 7Department of Medicine, Royal Melbourne Hospital, Parkville, Australia
Biography:
Emily Moroney is a current Basic Physicians Trainee at St Vincents Hospital Melbourne. Emily has presented at ADIPS/SOMANZ and Australasian Diabetes conferences and has first author publications in International Journal of Cardiology & Obstetric Medicine. Emily has a keen interest in obstetric medicine, endocrinology and congenital heart disease in pregnancy.
Abstract:
Pregnancy in women with a Fontan circulation is categorised as mWHO class III or IV – significantly, or extremely, high risk of maternal mortality or severe morbidity. Previous data from the Australia and New Zealand (ANZ) Fontan registry demonstrated a signal for increased thromboembolic events (TE) in women post pregnancy (PP), limited by cohort size and follow up. This updated analysis (additional 5 years of data), was undertaken to further inform whether pregnancy has a legacy effect on the maternal health of women with a Fontan circulation. A total 747 eligible adults (402 males, 345 females) were identified. Details surrounding original cardiac morphology, Fontan procedure, pregnancy, cardiac and Fontan complications was ascertained. The female cohort was divided into those with (n = 48) and without (n = 297) recorded pregnancy, defined as pregnancy >=20 weeks gestation.
An additional 204 adults (28 women with a pregnancy) were included to the initial analysis. Mean age at first pregnancy was 28.0 years (SD 4.1 years) and median follow-up time PP was 6.0 years (2.1–10.5).
Incidence rate ratio (IRR) of cardiac events (TE, arrhythmia, cardioversion, pacemaker insertion, Fontan takedown, Fontan conversion, transplant or death) was calculated. In comparison with the pregnancy cohort, pre pregnancy, this was highest in men (p = 0.007) and no different to the never pregnant group (p = 0.054). In contrast, it was greater PP compared with men (p = 0.026), never pregnant women (p = 0.003) and compared to the pre-pregnancy event rate (p<0.001). Although propensity-matching attenuated this finding (p = 0.285), this may reflect smaller numbers of women included in that analysis.
This suggests that pregnancy can herald cardiac event onset. This is important to further inform pre- pregnancy counselling. The possibility that a stronger conclusion has been limited by the
numbers in this study is recognised.
Keywords
Pregnancy, Congenital Heart Disease, Maternal Health
References
1. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39: 3165-3241. 2018/08/31. DOI: 10.1093/eurheartj/ehy340.
2. Moroney E, Zannino D, Cordina R, et al. Does pregnancy impact subsequent health outcomes in the maternal Fontan circulation? Int J Cardiol 2020; 301: 67-73. 2019/10/03. DOI: 10.1016/j.ijcard.2019.08.039.