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Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Advances in medical treatment during the last 50 years have resulted in more individuals with congenital heart disease (CHD) and Marfan syndrome reaching childbearing age. The substantial physiological changes during pregnancy result in a high-risk situation, and pregnancy is a major concern in women with these conditions.

Aims

  • To describe the socio-demographic characteristics, birth characteristics and reproductive patterns of individuals with CHD and women with Marfan syndrome.
  • To investigate obstetric and neonatal outcomes in the firstborn children of individuals with CHD and women with Marfan syndrome.
  • To study long-term cardiovascular outcomes after childbirth in women with Marfan´syndrome.

Methods

The studies are population-based register studies. The study population in the first paper included all women born between 1973 and 1983 who were alive and resident in Sweden at the age of 13 (494 692 women, of whom 2 216 were women with CHD). In the second paper, the same definition of the study population was chosen, except that it involved all men born between 1973 and 1983 (522 216 men, of whom 2 689 men with CHD). The third and fourth papers involved a study population of all Swedish women born between 1973 and 1993 who were still living in Sweden at age 13. This population consisted of 1 017 538 women, 273 of whom had been diagnosed with Marfan syndrome.

Results and conclusions

The individuals studied were more often born preterm, and were small-for-gestational age babies. They were more likely to have been born by cesarean section. In women with CHD, these characteristics were repeated in their firstborn children. No increased risks were found in children of men with CHD or in children of women with Marfan syndrome. There was no increased risk of aortic dissection in women with Marfan syndrome during pregnancy compared to women with Marfan syndrome who did not give birth. Higher frequencies of cardiac arrhythmia and valvular heart disease were found after childbirth in women with Marfan syndrome. Pregnancy in women with CHD is a high-risk situation associated with increased risk of adverse neonatal outcomes for the expected child. Pregnancy in women without CHD, but where the father has CHD is not so associated with increased risk of adverse obstetric or neonatal outcomes. Pregnancy in women with Marfan syndrome is not associated with adverse outcomes for the expected child.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. , 70 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1565
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology Family Medicine Pediatrics Clinical Science
Identifiers
URN: urn:nbn:se:liu:diva-134854DOI: 10.3384/diss.diva-134854ISBN: 9789176855713 (print)OAI: oai:DiVA.org:liu-134854DiVA: diva2:1077354
Public defence
2017-03-24, Föreläsningssal Eken, Campus US, Linköing, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-02-27 Created: 2017-02-27 Last updated: 2017-03-31Bibliographically approved
List of papers
1. Reproductive patterns and pregnancy outcomes in women with congenital heart disease - a Swedish population-based study
Open this publication in new window or tab >>Reproductive patterns and pregnancy outcomes in women with congenital heart disease - a Swedish population-based study
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2011 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 6, 659-665 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To study women diagnosed with congenital heart disease (CHD) with respect to characteristics related to their own births, their subsequent likelihood of giving birth and the obstetric and neonatal outcomes of their pregnancies. Design. Population-based register study. Population. All women born in 1973-1983 who were alive and living in Sweden at 13 years of age (n=500 245). Methods. Women diagnosed with CHD (n=2 216) were compared with women without CHD (n=492 476). A total of 188 867 mother-firstborn-offspring pairs were identified and available for analysis. Results. Mothers of women with CHD were more often older and single/unmarried. Women with CHD were more often born preterm or small-for-gestational age (SGA) than women without CHD, more likely to have been born with a cesarean section, to have given birth during the study period, and to be younger at the time of their first pregnancy. Women with CHD were also more prone to give birth to children preterm or SGA and their babies were more often delivered by cesarean section with a higher frequency of congenital abnormality. Conclusions. Women with CHD were more likely to have been born preterm or SGA and these outcomes were repeated in the next generation. Women with CHD should not be discouraged from pregnancy. Prenatal diagnostics should be discussed and offered to these women, as there is an increased risk for congenital abnormalities.

Place, publisher, year, edition, pages
Wiley, 2011
Keyword
Congenital heart disease; reproduction; high-risk pregnancy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-69887 (URN)10.1111/j.1600-0412.2011.01100.x (DOI)000291433600016 ()
Available from: 2011-08-09 Created: 2011-08-08 Last updated: 2017-12-08
2. Congenital heart disease in men - birth characteristics and reproduction: a national cohort study.
Open this publication in new window or tab >>Congenital heart disease in men - birth characteristics and reproduction: a national cohort study.
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2014 (English)In: BMC pregnancy and childbirth, ISSN 1471-2393, Vol. 14, 187- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Women with congenital heart disease (CHD) are more often born preterm or small-for-gestational age and with a caesarean section. This pattern together with an increased risk of congenital anomalies seems to be repeated in the next generation. Information on the effect of paternal CHD on their offspring is sparse. In this study we investigated if men with CHD differ from those who do not have CHD with respect to characteristics related to their own births, their reproductive patterns and the neonatal outcomes of their children.

METHODS: In this national cohort study data were derived from Swedish population-based registries. The population consists of all men born in 1973-1983 who were alive and living in Sweden at 13 years of age (n = 522 216). The index group is men with CHD (n = 2689). Men diagnosed with CHD were compared with men without CHD. The CHD were also divided into two groups, complex and simple CHD and comparisons between the groups were made.

RESULTS: Men with CHD are more likely to have been born preterm (p < 0.001), small-for gestational-age (p < 0.001) or large-for-gestational-age (p < 0.001) than men without CHD. They are also more likely to have been the result of a twin pregnancy (p < 0.001) and to have been delivered by caesarean section (p < 0.001). Men with CHD have a decreased likelihood to become fathers compared to non-CHD men and in this study their offspring do not have a higher incidence of CHD than offspring to non-CHD fathers. The neonatal outcomes of children of men with CHD do not differ from the outcomes of children of non-CHD men.

CONCLUSIONS: Men with CHD were more often born with non-optimal characteristics compared to men without the condition. However, the increased risk does not repeat itself in the next generation. This knowledge can lead to improved preconception counselling for couples in which the father has a CHD.

Place, publisher, year, edition, pages
BioMed Central, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-115269 (URN)10.1186/1471-2393-14-187 (DOI)000338566400002 ()24890365 (PubMedID)2-s2.0-84905053219 (Scopus ID)
Available from: 2015-03-11 Created: 2015-03-11 Last updated: 2017-02-27Bibliographically approved

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