Hepatocyte growth factor,epidermal growth factor,and placenta growth factor concentrations in peripheral blood of pregnant women with alcohol abuse

BACKGROUND: Alcohol abuse during pregnancy compromises fetal development not only directly but also by abnormal placental function. Therefore, hepatocyte growth factor (HGF), epidermal growth factor (EGF), and placenta growth factor (PlGF), expressed in the placenta, may play a role in alcohol-induced placental dysfunction. METHODS: Peripheral venous blood samples were collected from 40 pregnant alcohol-abusing women and 42 abstinent pregnant women from gestational weeks 4 to 41. Plasma HGF and serum PlGF were assessed by enzyme-linked immunosorbent assays and serum EGF by an immunofluorometric assay. RESULTS: Plasma HGF concentrations were similar in alcohol-abusing and abstinent mothers, although in the latter women these concentrations increased with advancing pregnancy. Serum EGF concentrations were consistently higher in alcohol-abusing than in abstinent mothers. In the latter, these concentrations decreased with advancing pregnancy. Serum PlGF concentrations increased with advancing pregnancy in both groups and were higher in alcohol-abusing mothers during the second and third trimesters but not during the first. CONCLUSIONS: Alcohol abuse during pregnancy is associated with changes in maternal circulating EGF and PlGF but not HGF concentrations. The observed changes may be caused by alcohol per se or may be secondary to possible alcohol-induced changes in placental physiology.     

Outcomes of planned pregnancy in patients with systemic lupus erythematosus and their neonates

Aim of the workTo assess the outcome of planned pregnancies in patients with systemic lupus erythematosus (SLE). Patients and methods: The study was conducted on 32 patients. The medical management included pre-pregnancy planning at the quiescent phase of the disease and after at least six months of clinical remission. The patients had a monthly visit during pregnancy and three months post-delivery. Disease flare was characterized by the recurrence of symptoms and signs in different organs, as well as the need for an increase in medication dose. Results: There were 36 planned pregnancies in 32 patients, of which 15 and 17 cases were primiparous and multiparous, respectively. The SLE flares were observed in 36.1% of the cases, 8.3% of which developed postpartum; moreover, they were moderate in severity and mostly involved the kidneys and joints. Pregnancy outcomes included18 (50%) cases ended in term labor; 13 (36.1%) pregnancies had preterm labor, and 5 (13.8%) pregnancies terminated with abortions. Furthermore, obstetric complications included 2(6.5%) patients with premature rupture of membranes, 5(15.6%) fetuses with intrauterine growth retardation, and 2(6.4%) mothers with preeclampsia. 10(27.7%) pregnancies occurred in patients with lupus nephritis. Cesarean section was performed on 24(77.4%) patients, and low birth weight was observed in 7(21.8%) infants. None of the infants had neonatal lupus, congenital deformities or infection. Conclusion: Pre-pregnancy planning in patients with SLE can considerably improve pregnancy outcomes. Neonatal lupus, congenital anomalies or infection were not present. SLE patients intending to become pregnant should be provided with close medical supervision for a safe maternal and fetal outcome.     

Managing Q fever during pregnancy: the benefits of long-term cotrimoxazole therapy.

BACKGROUND: Q fever is a zoonosis caused by Coxiella burnetii. During pregnancy, it may result in obstetric complications, such as spontaneous abortion, intrauterine growth retardation, intrauterine fetal death, and premature delivery. Pregnant women are exposed to the risk of chronic Q fever. METHODS: We included 53 pregnant women who received a diagnosis of Q fever. We compared the incidence of obstetric and maternal Q fever complications for women who received long-term cotrimoxazole treatment (n=16) with that for women who did not receive long-term cotrimoxazole treatment (n=37); long-term cotrimoxazole treatment was defined as oral administration of trimethoprim-sulfamethoxazole during at least 5 weeks of pregnancy. RESULTS: Obstetric complications were observed in 81.1% of pregnant women who did not receive long-term cotrimoxazole therapy: 5 (13.5%) women experienced spontaneous abortions, 10 (27%) experienced intrauterine growth retardation, 10 (27%) experienced intrauterine fetal death, and 10 (27%) experienced premature delivery. Oligoamnios was observed in 4 patients (10.8%). Obstetric complications were found to occur significantly more often in patients infected during their first trimester of pregnancy than in those infected later (P=.032). The outcome of the pregnancy was found to depend on placental infection by C. burnetii (P=.013). Long-term cotrimoxazole treatment protected against maternal chronic Q fever (P=.001), placental infection (P=.038), and obstetric complications (P=.009), especially intrauterine fetal death (P=.018), which was found to be related to placental infection (P=.008). CONCLUSIONS: Q fever during pregnancy results in severe obstetric complications, including oligoamnios. Because of its ability to protect against placental infection, intrauterine fetal death, and maternal chronic Q fever, long-term cotrimoxazole treatment should be used to treat pregnant women with Q fever.     

Modification of maternal and congenital cytomegalovirus infection by anti-glycoprotein b antibody transfer in guinea pigs

Prepregnancy human and guinea pig cytomegalovirus immunity reduces rates of congenital infection in subsequent pregnancies. Inbred JY-9 strain guinea pigs were used to study the role of hyperimmune anti-glycoprotein B (gB) serum in modification of congenital infection in early pregnancy. Significantly shorter duration of primary maternal viremia and fewer pregnancy losses occurred in passively immunized dams, compared with nonimmune dams. Placentas from recipients of negative control serum were smaller and had marked mononuclear cell infiltrates and focal necrosis and more viral foci than did those from recipients of anti-gB hyperimmune serum. Significantly higher intrauterine growth retardation occurred in pups of negative control serum recipients than in pups of passively immunized dams. Significantly higher proportions of pups and placentas from recipients of negative control serum were positive on viral culture than from passively immunized dams. Thus, anti-gB passive immunization decreased fetal infection and intrauterine growth retardation, shortened maternal viremia, and reduced pregnancy losses and placental inflammation and infection.     

Chronic Ethanol Exposure Inhibits Insulin and IGF-1 Stimulated Amino Acid Uptake in Cultured Human Placental Trophoblasts

Maternal alcohol abuse during pregnancy can lead to abnormalities in fetal development, sometimes manifested as the fetal alcohol syndrome (FAS). Although intrauterine growth retardation is a hallmark of FAS, the pathophysiology is not fully understood. A contributing factor may be altered placental function. In this study, the effect of long-term exposure to ethanol on subsequent amino acid uptake by the cultured human placental trophoblasts was examined. Both Na⁺-dependent and Na⁺-independent pathways for AIB uptake were measured. As reported previously, insulin and IGF-1 enhanced Na⁺-dependent AIB uptake. Exposure to ethanol had no effect on basal (nonhormone treated) AIB uptake. However, 72-hr ethanol pretreatment of trophoblasts inhibited Na⁺-dependent AIB uptake under stimulation by insulin or IGF-1 in the absence of ethanol. Na⁺-independent uptake was not affected. Ethanol treatment had no effect on insulin or IGF-1 binding to cultured trophoblasts. These findings suggest that 72-hr ethanol treatment in cultured trophoblasts may affect postreceptor signal transduction in the insulin or IGF-1 pathways. Such changes have implications for the effect of ethanol on normal function of the human placenta, the major interface for maternal/fetal transfer of nutrients.     

Ethanol Alters Hormone Production in Cultured Human Placental Trophoblasts

Maternal alcohol abuse during pregnancy can lead to abnormalities in fetal development, including the fetal alcohol syndrome (FAS). Although intrauterine growth retardation is a hallmark of FAS, the pathophysiology is not fully understood. A contributing factor may be altered placental function, which could affect fetal growth and development. As a major endocrine organ during pregnancy, changes in the production of placental hormones could affect pregnancy and possibly fetal development. In this study, the effect of continued exposure to ethanol on placental hormone production was examined using cultured human placental trophoblasts. Ethanol exposure involved diffusion of ethanol from the atmosphere into the culture medium. This was refreshed daily, leading to daily peak concentrations of 280 to 300 mg/dl (60-65 mM) at 16 to 24 hr. This ethanol exposure for 2 or 4 days significantly increased the production of human chorionic gonadotropin and progesterone by the cultured trophoblasts. However, ethanol treatment had no effect on human placental lactogen production. Acute stimulation (10 min) of cultured trophoblasts with adenosine (50 μM) normally results in increased production of cyclic adenosine 3′,5′-monophosphate (CAMP). With ethanol exposure, adenosine-stimulated cAMP production was significantly elevated relative to that in controls. However, the effect of ethanol on adenosine-stimulated cAMP did not appear to be secondary to chronic alterations in adenosine in the culture medium. Measurement of adenosine in the culture medium revealed no difference in concentration or production between control and ethanol treated groups. Moreover, chronic (24 hr) pretreatment of trophoblasts with 0.2 to 10 μM additional adenosine before acute adenosine stimulation did not alter the cAMP response in either control or ethanol-treated cells. This study demonstrates that ethanol exposure may alter placental production of hormones, specifically those that are cAMP dependent.     

Celiac disease and risk of adverse fetal outcome: a population-based cohort study

BACKGROUND & AIMS: Studies of maternal celiac disease (CD) and fetal outcome are inconsistent, and low statistical power is likely to have contributed to this inconsistency. We investigated the risk of adverse outcomes in women with CD diagnosed prior to pregnancy and in women who did not receive a diagnosis of CD until after the delivery. METHODS: A national register-based cohort study restricted to women aged 15-44 years with singleton live born infants was used. We identified 2078 offspring to women who had received a diagnosis of CD (1964-2001): 1149 offspring to women diagnosed prior to birth and 929 offspring to women diagnosed after infant birth. Main outcome measures were: intrauterine growth retardation, low birth weight (<2500 g), very low birth weight (<1500 g), preterm birth (<37 gestational weeks), very preterm birth (<30 gestational weeks), and caesarean section. RESULTS: Undiagnosed CD was associated with an increased risk of intrauterine growth retardation (OR = 1.62; 95% CI: 1.22-2.15), low birth weight (OR = 2.13; 95% CI: 1.66-2.75), very low birth weight (OR = 2.45; 95% CI: 1.35-4.43), preterm birth (OR = 1.71; 95% CI: 1.35-2.17), and caesarean section (OR = 1.82; 95% CI: 1.27-2.60). In contrast, a diagnosis of CD made before the birth was not associated with these adverse fetal outcomes. CONCLUSIONS: Undiagnosed maternal CD is a risk factor for unfavorable fetal outcomes, but the risks are reduced when CD has been diagnosed. CD diagnosed prior to pregnancy does not constitute a great a risk as undiagnosed CD.     

Folgen von Alkohol und Rauchen in der Schwangerschaft

Nicotine and alcohol are legal drugs, which damage not only the health of the consumer, but also the society due to health-economic costs. In pregnancy, the consequences of alcohol consumption and smoking for the unborn life in pregnancy are dramatic. The irreversibly damaging effect of alcohol is proven in each stage of the pregnancy, whereby the phase of the organogenesis is the most sensitive period. Beside a higher incidence for deformations of all organs, the damage of the central nervous system is leading, since mental-intellectual retardation of children after alcohol consumption in pregnancy is proven. Smoking in pregnancy leads likewise to harmful effects, with the intrauterine growth retardation of the fetus being the leading smoking-induced pathology. Smoking- and alcohol-induced damages for the unborn life are irreversible with no therapeutic options. The only therapy is prevention, which means complete cessation of alcohol and smoking in pregnancy.     

Assessment of uterine placental circulation in thrombophilic women

Thrombophilia is associated with several complications of pregnancy including first and second trimester fetal loss, intrauterine fetal death, intrauterine growth restriction, preeclampsia, and placental abruption. Few studies have documented thrombotic lesions observed on the pathologic examination of the placenta in women with severe pregnancy complications. Moreover, a significantly higher rate of factor V Leiden and prothrombin G20210A gene mutations have been found in placentas with thrombotic events compared with normal placentas. In addition, clinical studies have been performed, using Doppler ultrasonography, to assess the uterine placental circulation in women with thrombophilia. Doppler studies of the umbilical artery in cases of intrauterine growth retardation have shown a high systolic to diastolic ratio (S/D) ratio, suggesting an increase in the resistance of the placental small vessels. When these placental vessels were examined after delivery, significant differences were found in comparison with placental vessels of normal pregnancies. Most of the Doppler studies of the umbilical and uterine arteries in pregnancies with thrombophilia were performed in women with antiphospholipid antibodies. The other pathologic conditions associated with thrombophilia and complications of pregnancy were published only recently. These few studies have demonstrated abnormal umbilical and uterine arteries blood flow in complicated pregnancies. Finally, few Doppler studies also suggest improved uterine placental circulation when women with thrombophilia received thromboprophylaxis.     

Maternal alcohol abuse and neonatal infection

BACKGROUND: Since chronic alcohol use suppresses the adult immune system, we tested the hypothesis that maternal alcohol ingestion increases the risk of infection in term newborns. METHODS: Analysis of a large case-control study of birth weight for gestational age was performed focusing on maternal alcohol ingestion and the development of infection in term newborns > or =36 weeks gestation. After delivery, mothers were asked about alcohol and tobacco use in the 3 months prior to conception, the 1st, 2nd, and 3rd trimester of pregnancy. RESULTS: Eight hundred and seventy-two singleton newborns (872) > or = 36 weeks gestation were identified for analysis. A total of 51 (5.8%) had newborn infections. Gestational age, sex, and small for gestational age (SGA) were similar in the newborns with and without infection (p = NS). Infants whose mothers reported alcohol use, excessive drinking or smoking in pregnancy were more likely to have a newborn diagnosed with an infection than were mothers who reported abstaining from alcohol or cigarettes (p < 0.05). When controlling for race and smoking, SGA infants whose mothers used any alcohol had a 2.5-fold increase risk of infection, while excessive alcohol use increased the risk 3-4-fold. In a multivariable logistic regression analysis controlling for low maternal income, smoking, and SGA, excessive alcohol use during the 2 trimester increased the risk of newborn infection (OR 3.7 [1.1,12.8], p < 0.05). CONCLUSIONS: Excessive maternal alcohol use is associated with an increased risk of newborn infection in this patient sample. Increased awareness and further clinical investigations are warranted to address the detrimental effects of fetal alcohol exposure on the developing immune system.     

Alcohol-Related Birth Defects: Syndromal Anomalies, Intrauterine Growth Retardation, and Neonatal Behavioral Assessment

Fetal alcohol effects in 359 infants born to disadvantaged women identified as having a history of alcohol abuse or as controls and who provided reports of alcohol use in pregnancy are being studied in a prospective design. Alcohol abuse was assessed with the Michigan Alcoholism Screening Test (MAST). Alcohol use (AA/day) was based on short-term recall covering 2-week periods prior to each antenatal visit. A tally of anomalies associated with fetal alcohol syndrome was obtained in a blinded examination of each infant. This tally was significantly related to the MAST classification and, for the MAST+ subjects, the tally was related to first trimester AA/day. Birth weight, length, and head circumference were negatively correlated with AA/day (entire pregnancy); however, the effect was attenuated and not statistically significant in models with covariate control. It is possible that these measures were near the threshold of effect. Scale scores of the Brazelton Neonatal Behavioral Assessment Scale and three scale scores of the Graham/Rosenblith Behavioral Examination of the Neonate were unrelated to the MAST classification and to AA/day.     

Feto-Maternal Circulatory Changes Related to Placenta Morphology in Diabetes Mellitus

Combined real-time Doppler ultrasound blood flow measurements were carried out in 20 diabetic pregnant women in the third trimester. The placenta morphology was examined with emphasis on maturation, centrocotyledon hemorrhage, villous edema, and ischemia, ischemic villitis, infarction, perivillous fibrin deposition, thrombosis, and inflammatory changes of membranes and fetal placental vessels. Ten out of 17 cases with placenta pathology had normal blood flow measurements. Centrocotyledon hemorrhage (n = 8) was associated with a higher pulsatility index in the fetal aorta and development of fetal distress and obstetric intervention in labor. The higher number of hemorrhages, the greater the risk of intervention. The pulsatility index was normal in the umbilical artery. The uterine artery pulsatility index showed no correlation to the hemorrhages. Ischemic villitis and infarction were not found in any placenta, suggesting that there were no cases of advanced placental dysfunction. Placental immaturity, found in 11 cases, was not associated with any flow anomalies. Centrocotyledon hemorrhage seemed to be the earliest morphological abnormality affecting blood flow in the feto-maternal circulation in diabetic pregnancy. Centrocotyledon hemorrhage might be the first sign of placental microflow disturbance, possibly affecting fetal oxygenation, but not the total placental vascular bed resistance.     

Contemporary treatments and outcomes of preterm infants with critical congenital heart disease in a tertiary cardiovascular institute in China

Background The survival rate of preterm infants with critical congenital heart disease(P-CCHD) has been improved by medicine advances. The aims of this study were to investigate the contemporary treatments for shortterm outcomes of P-CCHD and to evaluate risk factors associated with the outcomes. Methods Sixty-four PCCHD patients admitted to Guangdong General Hospital between 2011 and 2015 were included in this study. Demographic characteristics and patient records were reviewed. Logistic regression was used to analyze the risk factors of P-CCHD outcome. Results Thirty-six patients underwent surgical treatments for cardiac anomalies.Moreover, 31.25% of the P-CCHD infants did not receive surgery because these parents refused further treatment. The in-hospital mortality rate was 8.3% for the patients who underwent surgeries. During a median followup of 1.2 years, the survivors were basically healthy. However, mental and physical growth retardation remained.Conclusions Compared to infants in developed Western countries, the treatments and short-term outcomes of P-CCHD infants were satisfactory. However, the long-term outcomes remain to be determined.     

Intrauterine growth is related to gestational pulmonary function in pregnant asthmatic women. Kaiser-Permanente Asthma and Pregnancy Study Group

Asthmatic mothers have been reported to deliver infants of lower mean birth weight than nonasthmatic mothers. This study examined the relationship between intrauterine growth and serial gestational spirometry in 352 pregnant asthmatic women who were prospectively treated and observed during pregnancy. A small (r = 0.11) but significant (p less than 0.04) direct correlation was demonstrated between infant birth weight and individual mean percent predicted FEV1 during pregnancy. In addition, lower maternal mean FEV1 during pregnancy was associated with increased incidences of birth weight in the lower quartile of the infant population (p = 0.002) and ponderal indices less than 2.2 (suggestive of asymmetric intrauterine growth retardation) (p less than 0.05), but not with increased incidences of preterm (less than 38 weeks) or low birth weight (less than 2,500 g) infants. Although lower mean birth weight occurred in infants of smoking compared with nonsmoking asthmatic mothers (p less than 0.02), the relationships of lower FEV1 to birth weight in the lower quartile of the population (odds ratio 3.0, p = 0.002) and ponderal indices less than 2.2 (odds ratio 2.8, p less than 0.05) were shown by multivariate analysis to be above and beyond the influence of smoking and also independent of the effects of age, parity, acute asthmatic episodes, and asthma medications. These data support the hypothesis that lower maternal gestational FEV1 during pregnancy is related to intrauterine growth retardation and suggest that the goals of gestational asthma therapy should include optimization of pulmonary function in addition to achievement of symptomatic control.     

Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes

Background and aims: To examine the association between maternal hepatitis B and C mono‐ and co‐infections with singleton pregnancy outcomes in the state of Florida. Methods: We analysed all Florida births from 1998 to 2007 using birth certificate records linked to hospital discharge data. The main outcomes of interest were selected pregnancy outcomes including preterm birth, low birth weight (LBW), small for gestational age (SGA), fetal distress, neonatal jaundice and congenital anomaly. Results: The study sample consisted of 1 670 369 records. Human immunodeficiency virus co‐infection and all forms of substance abuse were more frequent in mothers with hepatitis B and C infection. After using multivariable modelling to adjust for important socio‐demographical variables and obstetric complications, women with hepatitis C infection were more likely to have infants born preterm [odds ratio (OR), 1.40; 95% confidence intervals (CI), 1.15–1.72], with LBW (OR, 1.39; 95% CI, 1.11–1.74) and congenital anomaly (OR, 1.55; 95% CI, 1.14–2.11). In addition, women with hepatitis B infection were less likely to have infants born SGA (OR, 0.79; 95% CI, 0.66–0.95). Conclusions: Our findings provide further understanding of the association between maternal hepatitis B or C carrier status and perinatal outcomes. Infants born to women with hepatitis C infection appear to be at risk for poor birth outcomes, including preterm birth, LBW and congenital anomaly.     

Effects of Prenatal Exposure to Alcohol, Smoking, and Illicit Drugs on Postpartum Somatic Growth

The association of fetal growth retardation with prenatal exposure to alcohol, smoking, opiates, and cocaine is well documented, but relatively little is known about the effects of these exposures on postpartum growth. This study assessed physical growth from birth through 6.5 and 13 months in 412 black, inner-city infants recruited on the basis of their mothers' use of alcohol and/or cocaine during pregnancy. Prenatal alcohol exposure was associated with a slower rate of growth during the first 6.5 postpartum months. This postnatal growth retardation was associated with maternal drinking during a critical period–the latter part of gestation–and was not related to drinking at the time of conception or to postnatal exposure to alcohol from breast-feeding. By contrast, smoking and cocaine use during pregnancy were associated with faster postnatal weight gain. Although maternal smoking was correlated with shorter stature at 6.5 and 13 months, this effect was attributable to maternal drinking during pregnancy, suggesting that the association of maternal smoking with shorter childhood stature reported elsewhere may be due to prenatal alcohol exposure, which was not controlled in prior studies.     

Asthma in pregnancy

Although about 1% of pregnant women have asthma, it is often underrecognized and suboptimally treated. The course of asthma during pregnancy varies; it improves, remains stable, or worsens in similar proportions of women. The risk of an asthma exacerbation is high immediately postpartum, but the severity of asthma usually returns to the preconception level after delivery and often follows a similar course during subsequent pregnancies. Changes in beta(2)-adrenoceptor responsiveness and changes in airway inflammation induced by high levels of circulating progesterone have been proposed as possible explanations for the effects of pregnancy on asthma. Good control of asthma is essential for maternal and fetal well-being. Acute asthmatic attacks can result in dangerously low fetal oxygenation. Chronically poor control is associated with pregnancy-induced hypertension, preeclampsia, and uterine hemorrhage, as well as greater rates of cesarian section, preterm delivery, intrauterine growth retardation, low birth weight, and congenital malformation. Women with well-controlled asthma during pregnancy, however, have outcomes as good as those in their nonasthmatic counterparts. Inhaled therapies remain the cornerstone of treatment; most appear to be safe in pregnancy.     

Melatonin improves placental efficiency and birth weight and increases the placental expression of antioxidant enzymes in undernourished pregnancy

Abstract:  Melatonin participates in circadian, seasonal and reproductive physiology. Melatonin also acts as a potent endogenous antioxidant by scavenging free radicals and upregulating antioxidant pathways. The placenta expresses melatonin receptors and melatonin protects against oxidative damage induced in rat placenta by ischemia-reperfusion. One of the most common complications in pregnancy is a reduction in fetal nutrient delivery, which is known to promote oxidative stress. However, whether melatonin protects placental function and fetal development in undernourished pregnancy is unknown. Here, we investigated the effects of maternal treatment with melatonin on placental efficiency, fetal growth, birth weight and protein expression of placental oxidative stress markers in undernourished pregnancy. On day 15 of pregnancy, rats were divided into control and undernourished pregnancy (35% reduction in food intake), with and without melatonin treatment (5 μg/mL drinking water). On day 20 of gestation, fetal biometry was carried out, the placenta was weighed and subsequently analyzed by Western blot for xanthine oxidase, heat shock protein (HSP) 27 and 70, catalase, manganese superoxide dismutase (Mn-SOD) and glutathione peroxidase 1 (GPx-1). A separate cohort was allowed to deliver to assess effects on birth weight. Maternal undernutrition led to a fall in placental efficiency, disproportionate intrauterine growth retardation and a reduction in birth weight. Maternal treatment with melatonin in undernourished pregnancy improved placental efficiency and restored birth weight, and it increased the expression of placental Mn-SOD and catalase. The data show that in pregnancy complicated by undernutrition, melatonin may improve placental efficiency and birth weight by upregulating placental antioxidant enzymes.     

Understanding the link between the placenta and future cardiovascular disease

Inadequate placental development results in a number of untoward pregnancy outcomes, including pre-eclampsia, placental abruption and infarction, and fetal growth restriction and stillbirth. Although it was once assumed that these pregnancy-related complications caused only upfront maternal and fetal morbidity and mortality, poor placental development and function is now a well-recognized female-specific risk factor for future vascular morbidity and mortality. The epidemiological, genetic, and physiological research linking placental development and cardiovascular disease is growing, and this knowledge will undoubtedly not only translate into improved pregnancy outcomes for at-risk women, but also help to identify which women who had a complicated pregnancy could benefit from long-term follow-up and risk modification for cardiovascular disease. This article reviews the literature and provides suggestions for future follow-up of this vulnerable population of women.     

Cardiac risks and management of complications in pregnant women with congenital heart disease

There are a growing number of women with congenital heart disease reaching adulthood and contemplating and/or undergoing pregnancy. However, pregnancy imposes hemodynamic stress on the heart and this can result in maternal, fetal and neonatal complications. Most women with congenital heart disease do well during pregnancy, but some women with high-risk cardiac lesions will not tolerate the hemodynamic changes of pregnancy. Physicians must be aware of the potential risks for the mother both during and after pregnancy, the risks to the fetus and neonate, and the risks and benefits of medications and procedures used during pregnancy. For women with complex cardiac conditions, management during pregnancy benefits from multidisciplinary care involving cardiologists with expertise in pregnancy, obstetricians with expertise in maternal fetal medicine, neonatologists and obstetric anesthetists, among others. This review will focus on the cardiac risks faced by women with congenital heart disease; particularly those at high risk, and on management strategies to mitigate risk and address cardiac complications.