Pregnancy in Women with Congenital Heart Disease: A Guide for the General Cardiologist

Dyspnea, palpitations, edema, and fatigue are common symptoms during pregnancy. For women with congenital heart disease (CHD), it may be difficult to discern whether symptoms are due to normal pregnancy or underlying cardiac disease. Although most women with CHD tend to experience successful pregnancies, morbidity and mortality are significantly increased with more complex CHD lesions. Women with CHD are at risk for arrhythmias, heart failure (HF), thromboembolic complications, and preeclampsia. Risks to the fetus also exist, including premature birth, small for gestational age (SGA), neonatal death, and the risk of recurrence of CHD. Many of these maternal complications can be treated, and perhaps even anticipated. As the number of maternal CHD pregnancies rises, clinical cardiologists should understand the complications with specific CHD conditions and know when to refer women for more specialized care. This review discusses common clinical case scenarios seen by the general cardiologist.