Cardiovascular diseases are the leading cause of maternal mortality within 42 days postpartum in France, representing a significant public health concern. Medical and surgical advancements now enable women with grown-up congenital heart (GUCH) to carry a pregnancy to term. However, recent data on maternal and neonatal morbidity and mortality in this population remain limited. This issue is of particular concern given that nearly two-thirds of cardiovascular-related maternal deaths are deemed preventable. This retrospective multicentric study aims to describe maternal and neonatal outcomes in pregnant women with GUCH.

A multicenter, retrospective cohort study included women with GUCH who underwent at least one pregnancy between 2015 and 2024 was conducted in three maternity centers in Marseille, France.

Ninety pregnant women were included yielding data for 129 pregnancies. The most common GUCH were tetralogy of Fallot (18.6%), ventricular septal defect (17.8%), and aortic coarctation (10.9%). No maternal deaths were observed. Only 6 (4,7%) pregnancies were planned. Twenty-three patients (17.8%) experienced at least one cardiovascular event during the pregnancy or within the year following delivery, with heart failure (8.5%) and arrhythmias (8.5%) being the most frequent. Twenty-one (16.3%) cesarean delivery for cardiac indication were performed, including 12 (9.3%) elective procedures. Preterm delivery (< 37 weeks of gestation) occurred in 23 pregnancies (17.8%), of which nine (7%) induced for maternal cardiac indication.

Women with GUCH face a high risk for cardiac, obstetric, and neonatal complications. Optimal management requires a multidisciplinary approach from preconception through postpartum period, which should be recognized as a “fourth trimester” of pregnancy.