AHA: Pregnancy Management With Congenital Heart Disease
The American Heart Association (AHA) released a scientific statement for healthcare practitioners on the management of pregnancy in patients with congenital heart disease.

As a result of the many medical advancements made in congenital heart disease, more women who are born with congenital heart disease will reach reproductive age. Therefore, the AHA writing committee recommends that all healthcare professionals involved in a patient's pregnancy be advised of the most up-to-date guidelines and information associated with the condition.

The World Health Organization categorizes patients into 4 pregnancy risk classes (I-IV), depending on their specific medical condition. (Note: patients in class I have no detectable increased risk for maternal mortality and either no or only mild increase in morbidity; therefore, they are not included in this document.) Patients in classes II and III may have small increases in maternal mortality or moderate increases in morbidity. Class IV patients may have an "extremely high risk" for maternal mortality or severe morbidity to the degree that pregnancy would be ill-advised. According to the AHA, the World Health Organization risk algorithm is considered the most reliable at determining maternal cardiovascular risk.
Preconception counseling is recommended for any patient with congenital heart disease. This initial diagnostic evaluation should include a detailed history of any current cardiovascular symptoms, as well as family history, medication review, arterial oxygen saturation, and baseline laboratory tests (eg, complete blood count, electrolytes, and thyroid and liver function), electrocardiogram, cardiopulmonary or exercise stress tests, comprehensive echocardiogram, and genetic counseling consideration. "If there is doubt about the presence or absence of pulmonary hypertension, cardiac catheterization should be performed," the authors wrote.