Pregnancy Outcomes in Women With Heritable Thoracic Aortic Disease: Data From the EORP Esc Registry of Pregnancy and Cardiac Disease (ROPAC) III

Authors

Puck N J Peters
Johanna A van der Zande
Julie De Backer
Guillaume Jondeau
Osama Ahmad
Marjorie Richardson
Francesca M Comoglio
Heleen van der Zwaan
Siddharth K Prakash
Christina Christersson
Karishma P Ramlakhan
Roger Hall
Mark R Johnson
Jolien W Roos-Hesselink
ROPAC investigators

Language

English

Publication Date

11-4-2025

Journal

European Heart Journal - Quality of Care and Clinical Outcomes

DOI

10.1093/ehjqcco/qcaf038

PMID

40576452

PMCID

PMC12587288

PubMedCentral® Posted Date

6-27-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Aims: The risk of pregnancy in women with heritable thoracic aortic disease (HTAD) is estimated to be high, but supporting data are scarce. The aim of this study is to prospectively investigate pregnancy outcomes to improve patient management and care.

Methods and results: The Registry of Pregnancy and Cardiac disease (ROPAC) III is a prospective global registry including pregnant women with known aortic pathology between 2018 and 2023. Cardiac, obstetric and fetal outcomes, beta-blocker use, and the impact of breastfeeding were investigated. Additionally, changes in aortic diameters were assessed. In total, 176 pregnancies in 170 women (mean age 32 years, 56% primigravida) with HTAD were included: 122 with Marfan syndrome, 14 with Loeys-Dietz syndrome, 10 with ACTA2 variants, and 30 with other diagnoses. There was no maternal or neonatal mortality, while six (3.4%) fetal deaths occurred. Thirteen (7.6%) women suffered a major adverse cardiac event (MACE), including six (3.5%) aortic dissections (three during and three after pregnancy). Beta-blockers were used throughout pregnancy by 83 (47%) women. Women taking beta-blockers did not experience less MACE, aortic dissection, or aortic growth. Breastfeeding women had a significantly lower occurrence of MACE compared with non-breastfeeding women. The aortic diameter showed significant growth during pregnancy.

Conclusion: The aortic dissection rate in this cohort of women with HTAD diagnosis prior to pregnancy, under surveillance in specialized clinics, was lower than previously reported. Our results suggest that pregnancy might have some effect on aortic growth and dissections did occur. This warrants close monitoring, also after delivery. Importantly, we found no association between breastfeeding and post-partum complications.

Keywords

Humans, Female, Pregnancy, Registries, Adult, Pregnancy Outcome, Pregnancy Complications, Cardiovascular, Prospective Studies, Aorta, Thoracic, Aortic Diseases

Published Open-Access

yes

Recommended Citation

Peters, Puck N J; van der Zande, Johanna A; De Backer, Julie; et al., "Pregnancy Outcomes in Women With Heritable Thoracic Aortic Disease: Data From the EORP Esc Registry of Pregnancy and Cardiac Disease (ROPAC) III" (2025). Faculty, Staff and Student Publications. 6436.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/6436