BACKGROUND Controversial results on maternal risk and fetal outcome have been reported in women with aortic
OBJECTIVES The authors sought to investigate maternal and fetal outcomes in patients with AS in a large cohort.
METHODS The Registry on Pregnancy and Cardiac Disease (ROPAC) is a global, prospective observational registry of
women with structural heart disease, providing a uniquely large study population. Data of women with moderate
(peak gradient 36 to 63 mm Hg) and severe AS (peak gradient $64 mm Hg) were analyzed.
RESULTS Of 2,966 pregnancies in ROPAC, the authors identified 96 women who had at least moderate AS (34 with
severe AS). No deaths were observed during pregnancy and in the first week after delivery. However, 20.8% of women
were hospitalized for cardiac reasons during pregnancy. This was significantly more common in severe AS compared with
moderate AS (35.3% vs. 12.9%; p ¼ 0.02), and reached the highest rate (42.1%) in severe, symptomatic AS. Pregnancy
was complicated by heart failure in 6.7% of asymptomatic and 26.3% of symptomatic patients, but could be managed
medically, except for 1 patient who was symptomatic before pregnancy and underwent balloon valvotomy. Children
of patients with severe AS had a significantly higher percentage of low birth weight (35.0% vs. 6.0%; p ¼ 0.006).
CONCLUSIONS Mortality in pregnant women with AS, including those with severe AS, appears to be close to zero in
the current era. Symptomatic and severe AS does, however, carry a substantial risk of heart failure and is associated with
high rates of hospitalization for cardiac reasons, although heart failure can nearly always be managed medically.
The results highlight the importance of appropriate pre-conceptional patient evaluation and counseling.