Background: Pregnancy causes changes in hormonal balance, several regulatory cycles, and hemodynamics to adapt to the new physiological conditions and to sufficiently provide oxygen and nutrients for the growing fetus. These adjustments increase the risk of cardiovascular adverse events, among others including hypertension, cardiac arrhythmias, and heart failure. Patients with congenital structural heart defects (e.g., aortic stenosis, persistent foramen ovale, tetralogy of Fallot) or (semi-)genetic cardiomyopathies (LQTS, SQTS, CPVT, BrS, ERS, DCM, H[O]CM, ARVC) were shown to be at greater risk of developing pregnancy-related complications. This study aims to elucidate the peripartum period, especially pearls and pitfalls in the treatment of pregnant women with preexisting heart disease.

Methods: We conducted a retrospective, single-center study including 145 adult pregnant women with preexisting heart disease, who underwent evaluation and treatment by the interdisciplinary pregnancy heart team of the University Hospital of Munich (LMU) between January 2002 and February 2022. All data, i.e. medical history, medication, physical examination, ECG, echocardiography, laboratory analysis, NYHA class, monitoring reports, and clinical notes, were taken from the central clinical database and analysed with subsequent strict data anonymization. Clinically relevant events occurring during pregnancy were recorded in a separate database. This is the primary analysis of these data which were exclusively compiled to investigate the peripartum period of women with preexisting heart disease.

Results¹: Among all patients included in this single-center experience, we observed little cardiovascular adverse events throughout the pregnancy. If all necessary safety precautions are taken according to current guidelines, in most cases the childbirth can be accomplished in the absence of relevant complications for mother and child.

¹ Preliminary; detailed results following in 02/2023

Conclusion: In this retrospective, single-center study we try to provide an in-depth insight into the everyday clinical practice of an interdisciplinary pregnancy heart team, at least comprising gynecologists, cardiologists and anaesthesiologists (if necessary, paediatrician-neonatologists and geneticists), monitoring adult pregnant women whileimplementing the current guidelines. Herein, we further could underline the importance of an early on risk stratification concerning the underlying cardiovascular conditions with risk-adapted therapy – from one-time presentation up to full inpatient treatment. Therefore, expecting women with congenital structural heart defects or cardiomyopathies should always be admitted to a specialized center for optimal individual treatment throughout the pregnancy.