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Pregnancy and Congenital Heart Disease pp 35–49Cite as

Preconception Counseling

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Part of the book series: Congenital Heart Disease in Adolescents and Adults ((CHDAA))

Abstract

Women with congenital heart disease have increased risk of cardiovascular, obstetric, and neonatal complications during pregnancy. They may also be at risk of cardiac function deterioration after pregnancy.

Adequate preconception counseling is important for these patients. Aims of counseling are informing patients about the risks of complications in order to help them make a well-informed choice on whether to pursue pregnancy. It also provides the opportunity to optimize medication before pregnancy, since contraindicated medications should be discontinued and of the remaining medication maternal benefit should be weighed against potential fetal harm. The preferred level of care and the importance of adherence to optimal care should be discussed.

Preconception counseling should address at least the maternal risk (based on modified WHO classification), whenever possible fetal risk, and medication should be reviewed. Preconception history taking, clinical examination, echocardiography, and exercise tolerance testing are the minimal requirements to enable a good risk assessment.

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Abbreviations

ACC:

American College of Cardiology

ACE:

Angiotensin-converting enzyme

AHA:

American Heart Association

ARBs:

Angiotensin receptor blockers

AVA:

Aortic valve area

CHD:

Congenital heart defect

CT:

Computed tomography

ESC:

European Society of Cardiology

FDA:

Food and Drug Administration

ICD:

Implantable cardioverter defibrillator

LMWH:

Low-molecular-weight heparin

LVOT:

Left ventricular outflow tract

MRI:

Magnetic resonance imaging

MVA:

Mitral valve area

NYHA:

New York Heart Association

ROPAC:

Registry of Pregnancy and Cardiac Disease

TPVR:

Total peripheral vascular resistance

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands

    M. A. M. Kampman MD, PhD & P. G. Pieper MD, PhD

Authors
  1. M. A. M. Kampman MD, PhD
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  2. P. G. Pieper MD, PhD
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Corresponding author

Correspondence to P. G. Pieper MD, PhD .

Editor information

Editors and Affiliations

  1. Erasmus MC University Medical Center, Rotterdam, Gelderland, The Netherlands

    Jolien W. Roos-Hesselink

  2. Chelsea and Westminster Hospital, London, United Kingdom

    Mark R. Johnson

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Kampman, M.A.M., Pieper, P.G. (2017). Preconception Counseling. In: Roos-Hesselink, J., Johnson, M. (eds) Pregnancy and Congenital Heart Disease. Congenital Heart Disease in Adolescents and Adults. Springer, Cham. https://doi.org/10.1007/978-3-319-38913-4_3

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  • DOI: https://doi.org/10.1007/978-3-319-38913-4_3

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