Heart and Circulation

Objective: We sought to determine if women who had an atrial switch procedure for d-transposition of the great arteries (d-TGA) are being counseled regarding pregnancy, and if the counseling is modified based on baseline cardiac function in accordance with American Heart Association/American College of Cardiology guidelines. Methods: Medical records of reproductive age women with an atrial switch repair for d-TGA receiving care at one tertiary center over 10 years were reviewed. Cardiology counseling recommendations regarding pregnancy made prior to the first conception, or in the case of nulligravid women, at the last routine encounter, were reviewed. Women who were instructed to avoid pregnancy were compared to those who were cleared for pregnancy. Univariate comparisons were made for baseline cardiac status and demographics. Odds ratios were generated using univariable logistic regression. Results: Pre-pregnancy counseling recommendations were made in 24/28 (85.7%) of encounters while no advice was given in the remainder. Of the women who received counseling, 12 (50%) were instructed to avoid pregnancy and 12 (50%) were cleared for pregnancy. Women who were counseled to avoid pregnancy did not differ from those cleared for pregnancy by: presence of pacemaker, cardiac medication use, NYHA classification, degree of tricuspid regurgitation, or prevalence of ventricular dysfunction. Patients instructed to avoid pregnancy were more likely to have been counseled by a pediatric cardiologist (OR 22.0, 95%CI 2.1, 236.1). Pregnancy occurred in 25% of those instructed to avoid pregnancy and 42% of those cleared for pregnancy (p=.7) prior to the next cardiology appointment. Conclusions: Cardiologists’ pre-pregnancy counseling efforts for women with a history of an atrial switch procedure for d-TGA appear to be subjective and not based on an individual patient’s cardiac status or current guidelines. When compared to adult congenital cardiology specialists, pediatric cardiologists are more likely to advise against pregnancy.