HeartPregnancy in Congenital Heart Disease: Risk Prediction and Counselling

🎓 Expert Commentary / Peer Perspective

Improved survival has increased the number of women with congenital heart disease considering pregnancy. Contemporary management relies on lesion-specific risk assessment, clinical risk scores, and multidisciplinary care to identify patients who can undergo pregnancy safely and those for whom pregnancy carries prohibitive risk.

Clinical Considerations

• mWHO classification remains the foundation of pregnancy risk assessment, guiding referral patterns and counseling intensity.
• Clinical predictors including heart failure, atrial arrhythmias, ventricular dysfunction, and valve disease refine individualized risk estimates.
• Pulmonary arterial hypertension, Eisenmenger syndrome, severe ventricular dysfunction, and significant aortic disease represent the highest-risk situations.
• Counseling should address maternal risk, fetal outcomes, medication safety, recurrence risk, contraception, and assisted reproduction.

Practice Applications

• Assess pregnancy risk using mWHO classification before conception.
• Integrate clinical risk factors alongside formal prediction tools.
• Counsel patients regarding maternal and fetal outcomes.
• Coordinate management through multidisciplinary pregnancy heart teams.
• Monitor high-risk patients in specialized tertiary centers.