Pregnancy-associated vascular complications and thoracic aortic growth patterns

Pregnancy induces hemodynamic stress that may predispose the thoracic aorta to accelerated growth or acute events. Here, we present a single-center experience with vascular outcomes in an obstetric population with thoracic aortic disease.

Electronic health records of pregnant patients with thoracic aortic aneurysm at our health care system were reviewed. Information was collected regarding demographics, aortic size, arterial complications, and clinical management of pregnancy.

Twenty-six patients with a total of 92 pregnancies (median per patient, 3; interquartile range, 2-4) were identified. Data were available for 39 pregnancies between 2011 and 2023. At the time of the first pregnancy, 23% (6 out of 26) of patients had no known diagnosis of thoracic aortic aneurysm, despite 2 patients known to have connective tissue disease. Among 26 patients, 57.7% (15 out of 26) had a heritable cause of thoracic aortic disease, whereas 42.3% (11 out of 26) had no identifiable etiology and were classified as sporadic dilations. Pregnancy-associated vascular complications occurred in 11.5% (3 out of 26) of patients. All vascular complications occurred in patients with heritable thoracic aortic disease. No type A aortic dissection was noted. Aortic surveillance and imaging schedules varied among patients.

Proximal aortic growth pattern is variable across pregnancy. No acute aortic events were observed during pregnancy. However, the risk of pregnancy-related vascular complications is higher during the postpartum period.