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January 26 2021
Research News: New HTAD collaborative publication on pregnancy outcomes in thoracic aortic disease
A new collaborative research paper entitled Pregnancy outcome in thoracic aortic disease data from the Registry Of Pregnancy And Cardiac disease has been published in Heart. It is co-authored by members of the VASCERN Heritable Thoracic Aortic Diseases Working Group (HTAD-WG) including Prof. Julie De Backer (Chair of HTAD-WG, Prof. Guillaume Jondeau (Co-Chair of HTAD-WG), and Jolien Roos-Hesselink (HTAD WG member).
This study analysed data from the Registry Of Pregnancy And Cardiac disease (ROPAC) in order to evaluate maternal and fetal outcome of pregnancy in 189 women with thoracic aortic disease (including heritable thoracic aortic diseases (HTAD) such as Marfan syndrome). The following endpoints were studied: death; cardiovascular events: aortic dissection (type A and B), need for aortic surgery or intervention; obstetric complications: pregnancy-induced hypertension, (emergent) caesarean section, premature birth and small for gestational age. It is the largest prospective data review to date on pregnancy risk for patients with thoracic aortic disease who elect to pursue pregnancy.
The overall complication rate was found to be low with favourable maternal and fetal outcomes.
In three of the four women who experienced an aortic dissection during pregnancy, the occurrence was the first presentation of the underlying disease, which highlights the importance of early recognition/diagnosis of these diseases and preconception counseling.
Type A dissections in patient with Marfan syndrome occurred at diameters above the 45mm guideline recommendation, suggesting a relatively safe margin.
The use of beta-blockers was low in the group studied with no significant effect on birth weight
Rates of caesarean section were high, despite lack of supporting data: further research addressing the mode and timing of delivery in thoracic aortic disease is warranted
Multidisciplinary approach with serial follow-up in expert centers throughout pregnancy and the postpartum period with an individualised plan for delivery is advised.
We congratulate the group on this important publication which highlights the importance of early recognition and diagnosis of HTAD as well as preconception counseling for those who are considering pregnancy.