Atrial septal defect and pregnancy


 * Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [mailto:psingh@perfuse.org]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
Pregnancy causes an increase in cardiac output and stroke volume. This can cause an increased left-to-right shunting of blood. Despite the increased workload on heart, females with isolated asymptomatic atrial septal defects tolerate the pregnancy well. Pregnant females with an atrial septal defect may have increased frequencies of some complications for instance arrhythmias, thromboembolism, and bleeding. Despite this, there are no studies suggesting that pregnancy requires different indications for closure in pregnant females with atrial septal defect compared to a non-pregnant female with atrial septal defect. The ACC/AHA guidelines, however, do dictate clear deviations in course of treatment in certain special circumstances. According to ACC/AHA guidelines pregnancy could be harmful in females with atrial septal defect and severe pulmonary hypertension (Eisenmenger syndrome)

==ACC/AHA recommendations for reproduction in patients with atrial septal defects (DONOT EDIT)==

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Class III
1. Pregnancy in patients with ASD and severe PAH (Eisenmenger syndrome) is not recommended owing to excessive maternal and fetal mortality and should be strongly discouraged. (Level of Evidence: A) }}

For ACC/AHA Level of evidence and classes click here.

Trial supportive data
1) Secundum atrial septal defects have been found to occur with increased frequencies in families. In a study done by Whittemore et al. the risk of having congenital heart disease in a child born to a mother with congenital heart disease has been found to somewhere between 8% to 10%..

2) In some studies the genes responsible for atrial septal defects has been shown to be located on chromosome 5 . An autosomal dominant inheritance with mutations in the cardiac transcription factor have been found. These heart defects have been found to be associated with some skeletal abnormalities like Holt-Oram syndrome. Both secundum and primum atrial septal defect have been found to be associated with trisomy 21 (Down syndrome).

3) In a study done by Weiss et al. maternal prognosis with pulmonary arterial disease in pregnancy was found to depend on the early diagnosis, early hospital admission, case specific management during pregnancy and good medical and post-partum care.