Aims Data on cardiovascular outcomes and aortic growth in pregnant women with Turner syndrome are limited. We examine the cardiovascular and pregnancy outcomes in these women and analyse aortic growth throughout pregnancy.

Methods and results The Registry of Pregnancy and Cardiac Disease III is a global, prospective, observational registry that enrolled pregnancies of women pre-pregnancy known with Turner syndrome from 2018 to 2023. We compared baseline characteristics and outcomes between women at low and moderate-to-high risk of aortic events and between women with a pregnancy conceived with assisted reproductive technology (ART) and those who conceived spontaneously. Linear mixed models were used to analyse aortic growth with the examinations and aortic diameter as independent and dependent variables, respectively, and random effects were used to account for repeated measurements. In total, 47 pregnancies were included, of which 49% were classified as moderate-to-high risk (bicuspid aortic valve, aortic dilatation, and/or hypertension), and 60% occurred after ART. No maternal mortality or dissection occurred during or after pregnancy. Hypertensive disorders occurred in 26%. No differences in pregnancy outcomes were found when comparing the risk groups, but women who conceived after ART were delivered by Caesarean section more often (65 vs. 42%; P = 0.011) and had earlier deliveries (38 vs. 39 weeks; P = 0.010) compared to women with a spontaneous conception. We observed a significant aortic growth at the sinus of Valsalva during pregnancy; however, aortic diameters during a median follow-up of 7 months were not different from pre-pregnancy diameters.

Conclusion Pregnancy outcomes in women known with Turner syndrome are better than reported before. While aortic dilatation may occur during pregnancy, it appears reversible postpartum. Attention for hypertension remains warranted

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