{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T07:16:37Z","timestamp":1784790997057,"version":"3.55.0"},"reference-count":19,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2024,9,13]],"date-time":"2024-09-13T00:00:00Z","timestamp":1726185600000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2024,8,22]]},"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Pregnant patients with single ventricle (SV) physiology carry a high risk of spontaneous pregnancy loss (SPL), yet the clinical factors contributing to this risk are not well defined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Single-centre retrospective study of pregnant patients with SV physiology seen in cardio-obstetrics clinic over the past 20 years with chart review of their obstetric history. Patients without a known pregnancy outcome were excluded. Univariable Bayesian panel-data random effects logit was used to model the risk of SPL.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The study included 20 patients with 44 pregnancies, 20 live births, 21 SPL and 3 elective abortions. All had Fontan palliation except for two with Waterston and Glenn shunts. 10 (50%) had a single right ventricle (RV). 14 (70%) had moderate or severe atrioventricular valve regurgitation (AVVR). Atrial arrhythmias were present in 16 (80%), Fontan-associated liver disease (FALD) in 15 (75%) and FALD stage 4 in 9 (45%). 12 (60%) were on anticoagulation. Average first-trimester oxygen saturation was 93.8% for live births and 90.8% for SPL. The following factors were associated with higher odds of SPL: RV morphology (OR 1.72 (95% credible interval (CrI) 1.0008\u20132.70)), moderate or severe AVVR (OR 1.64 (95% CrI 1.003\u20132.71)) and reduced first-trimester oxygen saturation (OR 1.83 (95% CrI 1.03\u20132.71) for each per cent decrease in O2 saturation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Pregnant patients with SV physiology, particularly those with RV morphology, moderate or severe AVVR, and lower first-trimester oxygen saturations, have a higher risk of SPL. Identifying these clinical risk factors can guide preconception counselling by the cardio-obstetrics team.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2024-002768","type":"journal-article","created":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T01:28:37Z","timestamp":1726450117000},"page":"e002768","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Predictors of spontaneous pregnancy loss in single ventricle physiology"],"prefix":"10.1136","volume":"11","author":[{"given":"Yasmine","family":"Wazni","sequence":"first","affiliation":[{"name":"Georgetown University, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Sefton","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betemariam","family":"Sharew","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Ghandakly","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Blazevic","sequence":"additional","affiliation":[{"name":"University of Toledo College of Medicine, Toledo, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nandini","family":"Mehra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Vascular & Thoracic Institute, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin R","family":"Lappen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Cleveland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara D","family":"Dolin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Cleveland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adina","family":"Kern-Goldberger","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Cleveland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Bacak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Cleveland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Vascular & Thoracic Institute, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Zahka","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Cleveland Clinic Children\u2019s, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"McKenney","sequence":"additional","affiliation":[{"name":"Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6976-1313","authenticated-orcid":false,"given":"Larisa G","family":"Tereshchenko","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Vascular & Thoracic Institute, Cleveland, Ohio, USA"},{"name":"Lerner Research Institute, Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Cleveland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter F","family":"Aziz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Cleveland Clinic Children\u2019s, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2596-1935","authenticated-orcid":false,"given":"Joanna","family":"Ghobrial","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Vascular & Thoracic Institute, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,9,13]]},"reference":[{"key":"2025081612220890000_11.2.e002768.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.03.085"},{"key":"2025081612220890000_11.2.e002768.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000696"},{"key":"2025081612220890000_11.2.e002768.3","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-307467"},{"key":"2025081612220890000_11.2.e002768.4","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1017\/S1047951111001661","article-title":"Longer-term issues for young adults with hypoplastic left heart syndrome: contraception, pregnancy, transition, transfer, counselling, and re-operation","volume":"21 Suppl 2","author":"Said","year":"2011","journal-title":"Cardiol Young"},{"key":"2025081612220890000_11.2.e002768.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccl.2012.05.004"},{"key":"2025081612220890000_11.2.e002768.6","first-page":"921","article-title":"Reproductive Issues in Patients With the Fontan Operation","volume":"38","author":"Wichert-Schmitt","year":"2022","journal-title":"Can J Cardiol"},{"key":"2025081612220890000_11.2.e002768.7","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1111\/chd.12750","article-title":"Accuracy of risk prediction scores in pregnant women with congenital heart disease","volume":"14","author":"Kim","year":"2019","journal-title":"Congenit Heart Dis"},{"key":"2025081612220890000_11.2.e002768.8","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq200"},{"key":"2025081612220890000_11.2.e002768.9","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ijcard.2020.09.033","article-title":"Comparison of risk stratification models for pregnancy in congenital heart disease","volume":"323","author":"Denayer","year":"2021","journal-title":"Int J Cardiol"},{"key":"2025081612220890000_11.2.e002768.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.02.076"},{"key":"2025081612220890000_11.2.e002768.11","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-311763"},{"key":"2025081612220890000_11.2.e002768.12","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCOUTCOMES.117.004575","article-title":"Pregnancy in Women With a Fontan Circulation: A Systematic Review of the Literature","volume":"11","author":"Garcia Ropero","year":"2018","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2025081612220890000_11.2.e002768.13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.ejogrb.2017.10.013","article-title":"Cardiovascular, obstetric and neonatal outcomes in women with previous fontan repair","volume":"219","author":"Bonner","year":"2017","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2025081612220890000_11.2.e002768.14","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.115.002414","article-title":"Maternal Cardiac Output and Fetal Doppler Predict Adverse Neonatal Outcomes in Pregnant Women With Heart Disease","volume":"4","author":"Wald","year":"2015","journal-title":"J Am Heart Assoc"},{"key":"2025081612220890000_11.2.e002768.15","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.89.6.2673"},{"key":"2025081612220890000_11.2.e002768.16","doi-asserted-by":"crossref","DOI":"10.1186\/s40949-017-0012-8","article-title":"Pregnancy outcomes in patients with a fontan circulation and proposal for a risk-scoring system: single centre experience","volume":"1","author":"Arif","year":"2017","journal-title":"J Congenit Heart Dis"},{"key":"2025081612220890000_11.2.e002768.17","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.ajog.2022.08.010","article-title":"Placental pathology is necessary to understand common pregnancy complications and achieve an improved taxonomy of obstetrical disease","volume":"228","author":"Redline","year":"2023","journal-title":"Am J Obstet Gynecol"},{"key":"2025081612220890000_11.2.e002768.18","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1253\/circj.CJ-21-0133","article-title":"Clinicopathologic Study of Placentas From Women With a Fontan Circulation","volume":"86","author":"Yokouchi-Konishi","year":"2021","journal-title":"Circ J"},{"key":"2025081612220890000_11.2.e002768.19","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.ijcard.2019.02.002","article-title":"The placenta: A site of end-organ damage after Fontan operation. A case series","volume":"289","author":"Phillips","year":"2019","journal-title":"Int J Cardiol"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2024-002768","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T19:22:18Z","timestamp":1755372138000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2024-002768"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,9,13]]},"published-print":{"date-parts":[[2024,9]]}},"alternative-id":["10.1136\/openhrt-2024-002768"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2024-002768","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}