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Aortic dissection rate low in pregnant women with Marfan syndrome
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In a cohort of pregnant women diagnosed with Marfan syndrome, the rate of aortic dissection was 1.9%, according to findings published in Heart.
A need for increased counseling and management for pregnant women with the disease was emphasized by the researchers.
Matthew Cauldwell, MBBS, BSc, MEd, MD, MRCP, MRCOG, and colleagues investigated the occurrence of CV complications and possible related factors, the impact of pregnancy on aortic diameters and other parameters.
“Pregnancy appears to increase the risk of [aortic dissection] in women with [Marfan syndrome], which is furthermore increased by pregnancy-related complications such as hypertension,” Cauldwell, a cardiology fellow at Chelsea and Westminster Hospital at Imperial College London, and colleagues wrote. “Both the European Society of Cardiology and the American Heart Association provide pregnancy management guidance, drawing from a limited number of studies.”
The researchers examined data from a multicenter, retrospective study of 221 live births in 139 women with Marfan syndrome between 1998 and March 2018. Only 50% of the patients received preconception counseling.
No mortalities were reported, but 1.9% of the women experienced aortic dissection (one type A and four type B), Cauldwell and colleagues wrote. Five women also required postpartum cardiac surgery.
The researchers could not identify any predictors for aortic dissection.
Offspring of 131 women taking beta-blockers were on average 316 g lighter (P < .001) than offspring born to women not on beta-blockers, Cauldwell and colleagues wrote. In women with dilated aortic roots, there was a 50% rate of caesarean section.
In 55 women, echocardiographic aortic imaging was available before and after pregnancy, the researchers wrote. In that subgroup, there average increase in aortic root dilation size from prepregnancy to postpregnancy was 0.84 mm.
“This study provides reassurance that the majority of women with Marfan syndrome and pregnancy will have a good outcome,” Cauldwell and colleagues wrote. “The benefit of using beta-blockers in Marfan syndrome in pregnancy remains unclear and is associated with lower fetal birth weight. Prospective randomized trials of their use may be justified.” – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.
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