Division of Cardiology, St.Paul's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
Division of Cardiology, Boston Children's Hospital, Harvard University, Boston, Massachusetts, USA.
Heart. 2021 Jan;107(1):61-66. doi: 10.1136/heartjnl-2020-316719. Epub 2020 Jul 15.
Women with Turner syndrome (TS) are frequently counselled against pregnancy due to lack of data and unclear aortic dissection risk. However, with advances in fertility therapy, more women with TS are contemplating pregnancy. This study compared rates of adverse cardiovascular (CV) outcomes among: (1) pregnant and non-pregnant women with TS and (2) pregnant women with TS with/without structural heart disease.
Retrospective analysis of pregnant and age-matched non-pregnant controls with TS (2005-2017) across 10 CV centres was done. Data were collected at initial evaluation in pregnancy and outcomes were assessed to 6 months postpartum. Adverse CV events were defined as CV death, aortic dissection/rupture and/or aortic intervention. Non-pregnant age-matched controls were followed over the same time period.
Sixty-eight pregnancies were included (60 women, mean age 33 years, 48% primigravid, 49% fertility therapy, 80% structurally normal heart, 25% XO karyotype). Based on American Society of Reproductive Medicine criteria, 10 pregnancies occurred in women stratified to high-risk category. There were no CV events in the pregnant women or in the non-pregnant women with TS. Obstetric events complicated 12 (18%) pregnancies with 9 (13%) attributed to hypertensive disorder of pregnancy. Fetal events included small for gestational age neonates (18%), preterm delivery (15%) and fetal death (3%).
This study helps to refine the approach to pregnancy in women with TS. Among women with TS without structural heart disease, pregnancy does not impose an increased risk of CV outcomes. Among women with TS with structural heart disease, the risk of pregnancy is not as prohibitive as previously described but does require ongoing evaluation.
由于缺乏数据和不明确的主动脉夹层风险，特纳综合征（TS）女性通常不建议怀孕。然而，随着生育治疗的进步，越来越多的 TS 女性正在考虑怀孕。本研究比较了以下人群的不良心血管（CV）结局发生率：（1）患有 TS 的妊娠和非妊娠妇女，以及（2）患有 TS 伴/不伴结构性心脏病的妊娠妇女。
对 10 个 CV 中心的 2005-2017 年间妊娠和年龄匹配的 TS 非妊娠对照者进行回顾性分析。在妊娠初始评估时收集数据，并在产后 6 个月时评估结局。不良 CV 事件定义为 CV 死亡、主动脉夹层/破裂和/或主动脉介入。对年龄匹配的非妊娠对照者在相同时间段内进行随访。
纳入 68 例妊娠（60 名女性，平均年龄 33 岁，48%初产妇，49%生育治疗，80%心脏结构正常，25% XO 核型）。根据美国生殖医学协会标准，10 例妊娠发生在高危分类的女性中。妊娠妇女或 TS 非妊娠妇女均无 CV 事件。12 例（18%）妊娠出现产科并发症，其中 9 例（13%）归因于妊娠高血压疾病。胎儿事件包括胎儿生长受限新生儿（18%）、早产（15%）和胎儿死亡（3%）。
本研究有助于完善 TS 女性妊娠方法。在无结构性心脏病的 TS 女性中，妊娠不会增加 CV 结局的风险。在有结构性心脏病的 TS 女性中，妊娠风险并非如先前描述的那样不可避免，但确实需要持续评估。
