Pregnancy in women with corrected aortic coarctation: Uteroplacental Doppler flow and pregnancy outcome

Anne S Siegmund, Marlies A M Kampman, Caterina M Bilardo, Ali Balci, Arie P J van Dijk, Martijn A Oudijk, Barbara J M Mulder, Jolien W Roos-Hesselink, Gertjan Tj Sieswerda, Steven V Koenen, Krystyna M Sollie-Szarynska, Tjark Ebels, Dirk J van Veldhuisen, Petronella G Pieper, ZAHARA investigators

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: Women with repaired coarctation of the aorta (rCoA) are at risk of hypertensive disorders and other complications during pregnancy. Hypertensive disorders in pregnant women are associated with inadequate uteroplacental flow, which is related to adverse offspring outcome. The aim of this study was to investigate the relationship of maternal cardiac function, placental function and pregnancy complications in women with rCoA.

METHODS: We included 49 pregnant women with rCoA and 69 controls from the prospective ZAHARA-studies (Zwangerschap bij Aangeboren HARtAfwijkingen, pregnancy in congenital heart disease). Clinical evaluation, echocardiography and uteroplacental Doppler flow (UDF) measurements were performed at 20 and 32weeks gestation. Univariable regression analysis was performed.

RESULTS: Comparison of rCoA and healthy women. In women with rCoA, tricuspid annular plane systolic excursion (TAPSE) decreased during pregnancy (25.7mm to 22.8mm, P=0.006). UDF indices and pregnancy complication rates were similar in both groups. Offspring of rCoA women had lower birth weight (3233g versus 3578g, P=0.001), which was associated with β-blocker use during pregnancy (β=-418.0, P=0.01). Association of cardiac function and UDF. Right ventricular (RV) function before pregnancy (TAPSE) and at 20weeks gestation (TAPSE and RV fractional area change) were associated with impaired UDF indices (umbilical artery pulsatility index at 20weeks β=-0.02, P=0.01, resistance index at 20 and 32weeks β=-0.01, P=0.02 and β=-0.02, P=0.01 and uterine artery pulsatility and resistance index at 20weeks gestation β=-0.02, P=0.05 and β=-0.01, P=0.02).

CONCLUSIONS: Women with rCoA tolerate pregnancy well. However, RV function is altered and is associated with impaired placentation.

Original languageEnglish
Pages (from-to)145-150
Number of pages6
JournalInternational Journal of Cardiology
Volume249
DOIs
Publication statusPublished - 15 Dec 2017

Cite this

Siegmund, A. S., Kampman, M. A. M., Bilardo, C. M., Balci, A., van Dijk, A. P. J., Oudijk, M. A., ... ZAHARA investigators (2017). Pregnancy in women with corrected aortic coarctation: Uteroplacental Doppler flow and pregnancy outcome. International Journal of Cardiology, 249, 145-150. https://doi.org/10.1016/j.ijcard.2017.09.167
Siegmund, Anne S ; Kampman, Marlies A M ; Bilardo, Caterina M ; Balci, Ali ; van Dijk, Arie P J ; Oudijk, Martijn A ; Mulder, Barbara J M ; Roos-Hesselink, Jolien W ; Sieswerda, Gertjan Tj ; Koenen, Steven V ; Sollie-Szarynska, Krystyna M ; Ebels, Tjark ; van Veldhuisen, Dirk J ; Pieper, Petronella G ; ZAHARA investigators. / Pregnancy in women with corrected aortic coarctation : Uteroplacental Doppler flow and pregnancy outcome. In: International Journal of Cardiology. 2017 ; Vol. 249. pp. 145-150.
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title = "Pregnancy in women with corrected aortic coarctation: Uteroplacental Doppler flow and pregnancy outcome",
abstract = "OBJECTIVE: Women with repaired coarctation of the aorta (rCoA) are at risk of hypertensive disorders and other complications during pregnancy. Hypertensive disorders in pregnant women are associated with inadequate uteroplacental flow, which is related to adverse offspring outcome. The aim of this study was to investigate the relationship of maternal cardiac function, placental function and pregnancy complications in women with rCoA.METHODS: We included 49 pregnant women with rCoA and 69 controls from the prospective ZAHARA-studies (Zwangerschap bij Aangeboren HARtAfwijkingen, pregnancy in congenital heart disease). Clinical evaluation, echocardiography and uteroplacental Doppler flow (UDF) measurements were performed at 20 and 32weeks gestation. Univariable regression analysis was performed.RESULTS: Comparison of rCoA and healthy women. In women with rCoA, tricuspid annular plane systolic excursion (TAPSE) decreased during pregnancy (25.7mm to 22.8mm, P=0.006). UDF indices and pregnancy complication rates were similar in both groups. Offspring of rCoA women had lower birth weight (3233g versus 3578g, P=0.001), which was associated with β-blocker use during pregnancy (β=-418.0, P=0.01). Association of cardiac function and UDF. Right ventricular (RV) function before pregnancy (TAPSE) and at 20weeks gestation (TAPSE and RV fractional area change) were associated with impaired UDF indices (umbilical artery pulsatility index at 20weeks β=-0.02, P=0.01, resistance index at 20 and 32weeks β=-0.01, P=0.02 and β=-0.02, P=0.01 and uterine artery pulsatility and resistance index at 20weeks gestation β=-0.02, P=0.05 and β=-0.01, P=0.02).CONCLUSIONS: Women with rCoA tolerate pregnancy well. However, RV function is altered and is associated with impaired placentation.",
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author = "Siegmund, {Anne S} and Kampman, {Marlies A M} and Bilardo, {Caterina M} and Ali Balci and {van Dijk}, {Arie P J} and Oudijk, {Martijn A} and Mulder, {Barbara J M} and Roos-Hesselink, {Jolien W} and Sieswerda, {Gertjan Tj} and Koenen, {Steven V} and Sollie-Szarynska, {Krystyna M} and Tjark Ebels and {van Veldhuisen}, {Dirk J} and Pieper, {Petronella G} and {ZAHARA investigators}",
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Siegmund, AS, Kampman, MAM, Bilardo, CM, Balci, A, van Dijk, APJ, Oudijk, MA, Mulder, BJM, Roos-Hesselink, JW, Sieswerda, GT, Koenen, SV, Sollie-Szarynska, KM, Ebels, T, van Veldhuisen, DJ, Pieper, PG & ZAHARA investigators 2017, 'Pregnancy in women with corrected aortic coarctation: Uteroplacental Doppler flow and pregnancy outcome' International Journal of Cardiology, vol. 249, pp. 145-150. https://doi.org/10.1016/j.ijcard.2017.09.167

Pregnancy in women with corrected aortic coarctation : Uteroplacental Doppler flow and pregnancy outcome. / Siegmund, Anne S; Kampman, Marlies A M; Bilardo, Caterina M; Balci, Ali; van Dijk, Arie P J; Oudijk, Martijn A; Mulder, Barbara J M; Roos-Hesselink, Jolien W; Sieswerda, Gertjan Tj; Koenen, Steven V; Sollie-Szarynska, Krystyna M; Ebels, Tjark; van Veldhuisen, Dirk J; Pieper, Petronella G; ZAHARA investigators.

In: International Journal of Cardiology, Vol. 249, 15.12.2017, p. 145-150.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Pregnancy in women with corrected aortic coarctation

T2 - Uteroplacental Doppler flow and pregnancy outcome

AU - Siegmund, Anne S

AU - Kampman, Marlies A M

AU - Bilardo, Caterina M

AU - Balci, Ali

AU - van Dijk, Arie P J

AU - Oudijk, Martijn A

AU - Mulder, Barbara J M

AU - Roos-Hesselink, Jolien W

AU - Sieswerda, Gertjan Tj

AU - Koenen, Steven V

AU - Sollie-Szarynska, Krystyna M

AU - Ebels, Tjark

AU - van Veldhuisen, Dirk J

AU - Pieper, Petronella G

AU - ZAHARA investigators

N1 - Copyright © 2017 Elsevier B.V. All rights reserved.

PY - 2017/12/15

Y1 - 2017/12/15

N2 - OBJECTIVE: Women with repaired coarctation of the aorta (rCoA) are at risk of hypertensive disorders and other complications during pregnancy. Hypertensive disorders in pregnant women are associated with inadequate uteroplacental flow, which is related to adverse offspring outcome. The aim of this study was to investigate the relationship of maternal cardiac function, placental function and pregnancy complications in women with rCoA.METHODS: We included 49 pregnant women with rCoA and 69 controls from the prospective ZAHARA-studies (Zwangerschap bij Aangeboren HARtAfwijkingen, pregnancy in congenital heart disease). Clinical evaluation, echocardiography and uteroplacental Doppler flow (UDF) measurements were performed at 20 and 32weeks gestation. Univariable regression analysis was performed.RESULTS: Comparison of rCoA and healthy women. In women with rCoA, tricuspid annular plane systolic excursion (TAPSE) decreased during pregnancy (25.7mm to 22.8mm, P=0.006). UDF indices and pregnancy complication rates were similar in both groups. Offspring of rCoA women had lower birth weight (3233g versus 3578g, P=0.001), which was associated with β-blocker use during pregnancy (β=-418.0, P=0.01). Association of cardiac function and UDF. Right ventricular (RV) function before pregnancy (TAPSE) and at 20weeks gestation (TAPSE and RV fractional area change) were associated with impaired UDF indices (umbilical artery pulsatility index at 20weeks β=-0.02, P=0.01, resistance index at 20 and 32weeks β=-0.01, P=0.02 and β=-0.02, P=0.01 and uterine artery pulsatility and resistance index at 20weeks gestation β=-0.02, P=0.05 and β=-0.01, P=0.02).CONCLUSIONS: Women with rCoA tolerate pregnancy well. However, RV function is altered and is associated with impaired placentation.

AB - OBJECTIVE: Women with repaired coarctation of the aorta (rCoA) are at risk of hypertensive disorders and other complications during pregnancy. Hypertensive disorders in pregnant women are associated with inadequate uteroplacental flow, which is related to adverse offspring outcome. The aim of this study was to investigate the relationship of maternal cardiac function, placental function and pregnancy complications in women with rCoA.METHODS: We included 49 pregnant women with rCoA and 69 controls from the prospective ZAHARA-studies (Zwangerschap bij Aangeboren HARtAfwijkingen, pregnancy in congenital heart disease). Clinical evaluation, echocardiography and uteroplacental Doppler flow (UDF) measurements were performed at 20 and 32weeks gestation. Univariable regression analysis was performed.RESULTS: Comparison of rCoA and healthy women. In women with rCoA, tricuspid annular plane systolic excursion (TAPSE) decreased during pregnancy (25.7mm to 22.8mm, P=0.006). UDF indices and pregnancy complication rates were similar in both groups. Offspring of rCoA women had lower birth weight (3233g versus 3578g, P=0.001), which was associated with β-blocker use during pregnancy (β=-418.0, P=0.01). Association of cardiac function and UDF. Right ventricular (RV) function before pregnancy (TAPSE) and at 20weeks gestation (TAPSE and RV fractional area change) were associated with impaired UDF indices (umbilical artery pulsatility index at 20weeks β=-0.02, P=0.01, resistance index at 20 and 32weeks β=-0.01, P=0.02 and β=-0.02, P=0.01 and uterine artery pulsatility and resistance index at 20weeks gestation β=-0.02, P=0.05 and β=-0.01, P=0.02).CONCLUSIONS: Women with rCoA tolerate pregnancy well. However, RV function is altered and is associated with impaired placentation.

KW - Journal Article

U2 - 10.1016/j.ijcard.2017.09.167

DO - 10.1016/j.ijcard.2017.09.167

M3 - Article

VL - 249

SP - 145

EP - 150

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -