PhD defence K.P. (Karishma) Ramlakhan

Summary:

Cardiac disease is pregnancy is a timely and increasingly relevant issue, already being a major cause of maternal mortality and morbidity. Both congenital and acquired cardiac diseases are predicted to become more prevalent in the pregnant population.

This PhD project uses data from the Registry of Pregnancy and Cardiac disease (ROPAC): a worldwide prospective registry of pregnancies in women with cardiac disease. We examined different types of cardiac disease, such as transposition of the great arteries (TGA) and aortic coarctation. We showed that pregnancy outcomes after arterial switch operation for TGA (which is currently not included in the guidelines because of a lack of evidence) are good. Women with an aortic coarctation have better outcomes than previously estimated, which means that their antenatal visits can be less intensive.
We showed which types of cardiac disease are associated with hypertensive disorders of pregnancy, like preeclampsia. More importantly, we found that women with both cardiac disease and preeclampsia have a shocking high mortality rate. We further investigated the perinatal outcomes after in-utero betablocker exposure and found a detrimental effect on birth weight, small for gestational age and neonatal congenital heart disease. We are the first to compare the six most commonly used betablockers in their effect on perinatal outcomes.

To conclude, this thesis on pregnancy and cardiac disease has attempted to contribute reliable data and new insights into a topic of increasing clinical relevance, and with a potentially great impact. After all, the ability to make informed choices about her reproductive health is a key issue in a woman’s life.