Congenital heart disease and pregnancy

Thanks to continuing progress in pediatric cardiac surgery and medical care, most women with congenital heart disease (CHD) reach childbearing age and consider pregnancy. Significant hemodynamic changes occur during normal pregnancy. Cardiac output increases by 50% while peripheral vascular resistance and blood pressure decrease. In the presence of maternal CHD, these hemodynamic changes can cause deterioration in cardiac functions, exacerbation of cardiac symptoms, and may result in maternal death and fetal loss. In spite of these complications, pregnancy is well tolerated in minimally symptomatic women with good ventricular function and normal oxygen saturation except in those with Eisenmenger syndrome, left heart obstruction, and Marfan syndrome. A planned pregnancy is preferable in women with CHD. Before pregnancy, maternal and fetal risks should be assessed, advisability of pregnancy must be determined, and if possible, cardiac abnormalities must be corrected or palliated. A careful and close follow-up is necessary during pregnancy. Women with high or intermediate risks should be referred for specialty care.