Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival

.............................................................................................................. 3 List of publications ............................................................................................. 7 Abbreviations with definitions .......................................................................... 8 Introduction ...................................................................................................... 11 Cardiovascular physiology of pregnancy and labor ........................................ 11 Long-term outcomes in general after childbirth ............................................. 13 Congenital heart disease .................................................................................. 14 Marfan syndrome ............................................................................................ 18 Adverse outcomes of pregnancy and childbirth .............................................. 21 Specific background to the present studies ..................................................... 23 Aims ................................................................................................................... 25 Material and methods ...................................................................................... 27 Study design and study population ................................................................. 27 Registers .......................................................................................................... 34 Statistics .......................................................................................................... 36 Ethical considerations ..................................................................................... 37 Results and comments ...................................................................................... 39 Birth characteristics of individuals with CHD ................................................ 39 Specific results in Paper I: Women with CHD ............................................... 39 Specific results in Paper II: Men with CHD ................................................... 40 Birth characteristics of women with Marfan syndrome .................................. 41 Specific results in Paper III: Women with Marfan syndrome ........................ 42 Specific results in Paper IV: Long-term cardiovascular outcomes after childbirth ......................................................................................................... 43 General discussion ............................................................................................ 45 Discussion of the methodology ....................................................................... 45 Discussion of the results ................................................................................. 49 Future research ................................................................................................. 55 Conclusions ....................................................................................................... 57 Populärvetenskaplig sammanfattning ............................................................ 59