Pregnancy Outcomes in Women after the Fontan Procedure

Area of Science:

• Cardiology
• Obstetrics
• Reproductive Medicine

Background:

• Women with single ventricle physiology post-Fontan procedure can achieve adulthood and conceive.
• Pregnancy imposes hemodynamic stress on Fontan circulation, though typically manageable unless Fontan circulation is failing.

Purpose of the Study:

• To evaluate maternal and fetal outcomes in pregnancies among women who have undergone the Fontan procedure.
• To assess the safety and risks associated with pregnancy in this specific patient population.

Main Methods:

• Retrospective analysis of pregnancies in women with Fontan circulation followed at two tertiary Polish medical centers (1995-2022).
• Inclusion of all pregnancies in women with a history of Fontan procedure.

Main Results:

• 15 women experienced 26 pregnancies, with 11 miscarriages and 16 live births.
• High rates of fetal complications (56.3%), notably prematurity (43.8%), and neonatal deaths (18.8%).
• Significant obstetrical complications (40%) including abruptio placentae, premature rupture of membranes, and antepartum hemorrhage; no maternal deaths or heart failure decompensation.

Conclusions:

• Pregnancy in women post-Fontan procedure is usually well-tolerated hemodynamically.
• Pregnancy is associated with a high risk of miscarriage and numerous obstetrical complications.
• These pregnancies necessitate multidisciplinary, specialized care from cardiologists and obstetricians.