NEW YORK - New data suggests
that women who have undergone a successful surgery to repair congenital heart
defects can become pregnant, but they may have clinically significant
complications.
Until recently, pregnancy was discouraged in women who have undergone the
so-called "Fontan operation" to correct complex birth defects of the heart.
However, case reports and one clinical study suggest that women can become
pregnant and deliver healthy infants.
To investigate further, Dr. Willem Drenthen, a cardiologist at the University
of Groningen, and his team identified 38 women ages 21 to 58 who had undergone
the heart surgery for various congenital heart defects.
Between 1986 and 2003, seven women tried to conceive, and six became pregnant
a total of 10 times, which resulted in four live births. There were two
premature deliveries, and two infants were small for gestational age.
All four births were accompanied by significant complications, including
deterioration in heart function, a dangerous heart arrhythmia called atrial
fibrillation, pregnancy-related high blood pressure, premature membrane rupture,
premature birth, fetal growth retardation and neonatal deaths. However, the
mothers' complications resolved fairly quickly afterwards.
Overall, infertility appears to be frequent in these women; many of the women
stopped menstruating, the investigators learned.
The authors reviewed the literature for studies regarding pregnancy after the
Fontan operation, which is named after the developer of the procedure. Overall,
obstetric complications were common, they report, with 15 of 39 completed
pregnancies ending with premature birth.
Drenthen's group concludes that the pregnancy is not likely to cause severe
complications among women whose Fontan palliation resulted in adequate repair.
However, based on the high miscarriage rates, other complications during
pregnancy, neonatal deaths, and lack of data regarding long-term outcomes, they
write, "these problems are important reasons to regard pregnancy as not
advisable."
SOURCE: Heart September 2006.
