Pregnancy outcomes after the Fontan repair

Area of Science:

• Cardiology
• Reproductive Medicine
• Pediatric Cardiology

Background:

• Increasing numbers of female Fontan operation survivors are reaching childbearing age.
• Previous recommendations discouraged pregnancy due to limited data.
• This study addresses the outcomes of pregnancy in this population.

Purpose of the Study:

• To determine the risks and outcomes of pregnancy and delivery following the modified Fontan operation.
• To evaluate maternal and infant health after Fontan procedure pregnancies.
• To inform future counseling regarding pregnancy in Fontan patients.

Main Methods:

• A mailed questionnaire was sent to 126 female patients from Fontan registries at Mayo Clinic and UCLA.
• An additional six cases of pregnancy post-Fontan operation were identified and reviewed.
• Pregnancy outcomes were assessed through collected data and case reviews.

Main Results:

• Thirty-three pregnancies were reported post-Fontan operation, resulting in 15 live births (45%) from 14 mothers.
• Pre-existing cardiac conditions were noted in some mothers; one developed supraventricular tachycardia during pregnancy.
• No maternal cardiac complications occurred during labor or the puerperium; infants were generally healthy with one atrial septal defect.

Conclusions:

• Pregnancy after the Fontan operation appears well-tolerated by most women.
• An increased risk of miscarriage is observed in this patient group.
• Current recommendations to routinely discourage pregnancy may require re-evaluation based on these findings.