Cardiovascular outcomes and aortic growth in pregnant women with Turner syndrome: data from the European Society of Cardiology EURObservational Research Programme Registry of Pregnancy and Cardiac Disease (ROPAC) III - Report - MDSpire

Cardiovascular outcomes and aortic growth in pregnant women with Turner syndrome: data from the European Society of Cardiology EURObservational Research Programme Registry of Pregnancy and Cardiac Disease (ROPAC) III

  • By

  • Johanna A van der Zande

  • Jasmin Grewal

  • Arie Franx

  • Joanna Hlebowicz

  • Laurent Demulier

  • Thelma C Konings

  • Abdulhalim J Kinsara

  • Julius C Mwita

  • Laurence Bal-Theoleyre

  • Wael Al Mahmeed

  • Lidija McGrath

  • Roger Hall

  • Mark R Johnson

  • Jolien W Roos-Hesselink

  • ROPAC investigators

  • R Ferrari

  • A Alonso

  • J Bax

  • C Blomström-Lundqvist

  • S Gielen

  • P Lancellotti

  • A P Maggioni

  • N Maniadakis

  • F Pinto

  • F Ruschitzka

  • L Tavazzi

  • P Vardas

  • F Weidinger

  • U Zeymer

  • A Vahanian

  • A Budaj

  • N Dagres

  • N Danchin

  • V Delgado

  • J Emberson

  • O Friberg

  • C P Gale

  • G Heyndrickx

  • B Iung

  • S James

  • A P Kappetein

  • A P Maggioni

  • N Maniadakis

  • K V Nagy

  • G Parati

  • A-S Petronio

  • M Pietila

  • E Prescott

  • F Ruschitzka

  • F Van de Werf

  • F Weidinger

  • U Zeymer

  • C P Gale

  • B Beleslin

  • A Budaj

  • O Chioncel

  • N Dagres

  • N Danchin

  • J Emberson

  • D Erlinge

  • M Glikson

  • A Gray

  • M Kayikcioglu

  • A P Maggioni

  • K V Nagy

  • A Nedoshivin

  • A-P Petronio

  • J W Roos-Hesselink

  • L Wallentin

  • U Zeymer

  • B A Popescu

  • D Adlam

  • A L P Caforio

  • D Capodanno

  • M Dweck

  • D Erlinge

  • M Glikson

  • J Hausleiter

  • B Iung

  • M Kayikcioglu

  • P Ludman

  • L Lund

  • A P Maggioni

  • S Matskeplishvili

  • B Meder

  • K V Nagy

  • A Nedoshivin

  • D Neglia

  • A A Pasquet

  • J W Roos-Hesselink

  • F J Rossello

  • S M Shaheen

  • A Torbica

  • Jolien Roos-Hesselink

  • Roger Hall

  • William Parsonage

  • Werner Budts

  • Julie De Backer

  • Jasmin Grewal

  • Ariane Marelli

  • Guillaume Jondeau

  • Mark Johnson

  • Catherine Otto

  • Karen Sliwa

  • Aldo Maggioni

  • K Vardanyan

  • A Melkonyan

  • H Lachikyan

  • K Hakobyan

  • M Mazmanian

  • H Hayrapetyan

  • A Tavaracyan

  • H Poghosyan

  • R Hovhannisyan

  • S Sahakyan

  • S Martirosyan

  • J Harris

  • A Pasquet

  • M Morissens

  • T Besse-Hammer

  • B Dumoulin

  • J De Backer

  • L Campens

  • L Demulier

  • M De Hosson

  • W Budts

  • A Van de Bruaene

  • A Rampelberg

  • E Troost

  • L Roggen

  • P De Meester

  • J C Mwita

  • E Tefera

  • L Kontle

  • A Marelli

  • I Malhamé

  • J Grewal

  • M Janzen

  • P A Román Rubio

  • R Vasallo Peraza

  • G Vázquez Hernández

  • J E Pérez Torga

  • Y Gil Jiménez

  • M Meluzá Martín

  • R Almaleh

  • G Youssef

  • K Sorour

  • S Abebe

  • D Mekonnen

  • C Fekadu

  • D Yadeta

  • S Dupuis-Girod

  • L Delagrange

  • M Richardson

  • L Ghesquiere

  • O Domanski

  • M Gonzalez Estevez

  • Y Ould Hamoud

  • S Gautier

  • L Marsili

  • L Bal-Theoleyre

  • S Palazzolo

  • M Ladouceur

  • G Jondeau

  • A Bourgeois Moine

  • L Eliaou

  • O Milleron

  • M Tchitchinadze

  • Y Dulac

  • C Karsenty

  • N Souletie

  • F Bajanca

  • C Rickers

  • S Blankenberg

  • C Sinning

  • C Magnussen

  • E Zengin

  • G Mueller

  • R Schnabel

  • Y Von Kodolitsch

  • R Kozlik-Feldmann

  • H Baumgartner

  • R Schmidt

  • A Hellige

  • A Rietkötter

  • M Spartalis

  • A A Frogoudaki

  • A Arvanitaki

  • A Baroutidou

  • G Giannakoulas

  • C Karvounis

  • J P Gnanaraj

  • A P Steaphen

  • T Ethirajan

  • K Kannan

  • V Subramanian

  • A Surendran

  • J Gnanasekaran

  • V Natarajalingam

  • S Balasubramani

  • H Ali Farhan

  • I F Yaseen

  • E Mariucci

  • C Ciuca

  • F Marchi

  • G Benedetti

  • M Baroni

  • P Festa

  • A Parlanti

  • G Scognamiglio

  • F Fusco

  • B Sarubbi

  • M Merlo

  • B D'Agata Mottolese

  • C Carriere

  • G Sinagra

  • M Bobbo

  • F Ramani

  • F M Comoglio

  • R Bordese

  • A Pagano

  • N Montali

  • V Donvito

  • C A Remolif

  • F Petey

  • B Bouma

  • S Chamuleau

  • D Robbers-Visser

  • T Konings

  • H Dronkert

  • D Segers

  • R Van Kimmenade

  • H Van Der Zwaan

  • G Tjalling Sieswerda

  • A Evers

  • T Schaap

  • K Bano

  • H Yasmeen

  • K Amir

  • N Patel

  • P Akhter

  • R Khan

  • A Shakeel

  • S Mahar

  • S Habib

  • M Lelonek

  • P Hoffman

  • M Lipczynska

  • L De Sousa

  • V Ferreira

  • T Mano

  • M Selas

  • R Cruz Ferreira

  • E Shlyakhto

  • O Irtyuga

  • G Sefieva

  • K Malikov

  • T Pervunina

  • U Shadrina

  • A Kinsara

  • D Galzerano

  • H Al Sergani

  • W Kurdi

  • N Kholaif

  • O Vriz

  • A Alhamshari

  • A Alsaigh

  • O Ahmad

  • S Alzaher

  • B Alamro

  • K Sliwa

  • F Jakoet-Bassier

  • L Galian-Gay

  • A Pijuan-Domenech

  • B Miranda-Barrio

  • B Gordon

  • E Furenäs

  • J Hlebowicz

  • F Wedlund

  • E Nagy

  • E Mattsson

  • M Majczuk Sennstrom

  • P Sörensson

  • C Christersson

  • A Lutvica

  • B Jönelid

  • T Achter

  • K Junus

  • H Gärdesten Wall

  • M Andreasson

  • D Tobler

  • J Bouchardy

  • F Brand

  • C Blanche

  • J Bouchardy

  • T Rutz

  • F Brand

  • U Canpolat

  • Y Z Sener

  • N Ozer

  • E Ayduk Gövdeli

  • Z Bugra

  • B Umman

  • P Karaca Özer

  • D Baykiz

  • D Mutlu

  • H Yalman

  • B Kilickiran Avci

  • S Catirli Enar

  • O Batukan Esen

  • D Oksen

  • V Lazoryshynets

  • S Siromakha

  • Y Davydova

  • A Limanska

  • I Zinovchyk

  • V Kravchenko

  • B Kravchuk

  • O Kravets

  • N Volkova

  • O Mazur

  • O Beregovyi

  • B T Salih

  • W A R Al Mahmeed

  • S Wani

  • F S Mohamed Farook

  • G Al Mansoori

  • S Prakash

  • R Afifi

  • D Milewicz

  • A Cecchi

  • G Wells

  • D Sparks

  • W Wagner

  • C Bigelow

  • L Colicchia

  • T Jentink

  • M Loichinger

  • R Saxena

  • W Wunderlich

  • C Longtin

  • P Klopper

  • R Gobar

  • J Chou

  • K Campbell

  • R Elder

  • D Halpern

  • A Hausvater

  • H Reynolds

  • N Bhalla

  • A Small

  • J Feinberg

  • P Panday

  • J Awerbach

  • J Porche

  • S Stack

  • L McGrath

  • A Khan

  • E Pare

  • P Woods

  • C Broberg

  • K Gibbins

  • K Brookfield

  • M Al-Sadawi

  • A Cove

  • N Mann

  • September 8, 2025

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Cardiovascular and Aortic Growth Outcomes During Pregnancy in Women with Turner Syndrome

Overview

In a prospective study of 47 pregnancies in women with Turner syndrome, no maternal mortality or aortic dissection occurred. Significant aortic growth was observed during pregnancy but appeared reversible postpartum, while hypertensive disorders were common.

Background

Turner syndrome is a genetic condition affecting females, characterized by partial or complete loss of an X chromosome and associated with congenital heart defects such as bicuspid aortic valve and aortic aneurysm. Cardiovascular complications are the leading cause of increased mortality in these women. Pregnancy in Turner syndrome carries a risk of aortic dissection, especially with risk factors like hypertension and aortic dilatation. Assisted reproductive technology (ART) has increased pregnancy rates in this population but may be associated with higher pregnancy complications.

Data Highlights

ParameterValue
Total pregnancies included47
Moderate-to-high risk pregnancies (%)49%
Pregnancies after ART (%)60%
Maternal mortality0
Aortic dissection0
Hypertensive disorders during pregnancy (%)26%
Caesarean section rate after ART (%)65%
Caesarean section rate spontaneous conception (%)42%
Median delivery week ART38 weeks
Median delivery week spontaneous conception39 weeks

Key Findings

  • No maternal mortality or aortic dissection occurred during or after pregnancy in women with Turner syndrome.
  • Hypertensive disorders were present in 26% of pregnancies.
  • Women who conceived via assisted reproductive technology had higher Caesarean section rates (65% vs. 42%) and earlier deliveries (median 38 vs. 39 weeks) compared to spontaneous conception.
  • Significant aortic growth was observed at the sinus of Valsalva during pregnancy.
  • Aortic diameters returned to pre-pregnancy measurements during a median follow-up of 7 months, indicating reversibility of aortic dilatation postpartum.
  • No differences in pregnancy outcomes were found between low and moderate-to-high risk groups based on aortic risk factors.

Clinical Implications

Pregnancy in women with Turner syndrome, including those with moderate-to-high aortic risk, can be managed safely with close monitoring, as no maternal mortality or aortic dissection was observed. Attention to hypertensive disorders is critical given their prevalence. Assisted reproductive technology pregnancies may require increased surveillance due to higher Caesarean rates and earlier delivery.

Conclusion

Pregnancy outcomes in women with Turner syndrome are better than previously reported, with reversible aortic growth and no major cardiac events observed. Careful cardiovascular monitoring and management of hypertension remain essential during pregnancy in this population.

References

  1. European Society of Cardiology ROPAC III Registry Study 2018-2023 -- Cardiovascular and Aortic Growth Outcomes During Pregnancy in Women with Turner Syndrome

Original Source(s)

Cardiovascular outcomes and aortic growth in pregnant women with Turner syndrome: data from the European Society of Cardiology EURObservational Research Programme Registry of Pregnancy and Cardiac Disease (ROPAC) III

  • by Johanna A van der Zande, Jasmin Grewal, Arie Franx, Joanna Hlebowicz, Laurent Demulier, Thelma C Konings, Abdulhalim J Kinsara, Julius C Mwita, Laurence Bal-Theoleyre, Wael Al Mahmeed, Lidija McGrath, Roger Hall, Mark R Johnson, Jolien W Roos-Hesselink, ROPAC investigators, R Ferrari, A Alonso, J Bax, C Blomström-Lundqvist, S Gielen, P Lancellotti, A P Maggioni, N Maniadakis, F Pinto, F Ruschitzka, L Tavazzi, P Vardas, F Weidinger, U Zeymer, A Vahanian, A Budaj, N Dagres, N Danchin, V Delgado, J Emberson, O Friberg, C P Gale, G Heyndrickx, B Iung, S James, A P Kappetein, A P Maggioni, N Maniadakis, K V Nagy, G Parati, A-S Petronio, M Pietila, E Prescott, F Ruschitzka, F Van de Werf, F Weidinger, U Zeymer, C P Gale, B Beleslin, A Budaj, O Chioncel, N Dagres, N Danchin, J Emberson, D Erlinge, M Glikson, A Gray, M Kayikcioglu, A P Maggioni, K V Nagy, A Nedoshivin, A-P Petronio, J W Roos-Hesselink, L Wallentin, U Zeymer, B A Popescu, D Adlam, A L P Caforio, D Capodanno, M Dweck, D Erlinge, M Glikson, J Hausleiter, B Iung, M Kayikcioglu, P Ludman, L Lund, A P Maggioni, S Matskeplishvili, B Meder, K V Nagy, A Nedoshivin, D Neglia, A A Pasquet, J W Roos-Hesselink, F J Rossello, S M Shaheen, A Torbica, Jolien Roos-Hesselink, Roger Hall, William Parsonage, Werner Budts, Julie De Backer, Jasmin Grewal, Ariane Marelli, Guillaume Jondeau, Mark Johnson, Catherine Otto, Karen Sliwa, Aldo Maggioni, K Vardanyan, A Melkonyan, H Lachikyan, K Hakobyan, M Mazmanian, H Hayrapetyan, A Tavaracyan, H Poghosyan, R Hovhannisyan, S Sahakyan, S Martirosyan, J Harris, A Pasquet, M Morissens, T Besse-Hammer, B Dumoulin, J De Backer, L Campens, L Demulier, M De Hosson, W Budts, A Van de Bruaene, A Rampelberg, E Troost, L Roggen, P De Meester, J C Mwita, E Tefera, L Kontle, A Marelli, I Malhamé, J Grewal, M Janzen, P A Román Rubio, R Vasallo Peraza, G Vázquez Hernández, J E Pérez Torga, Y Gil Jiménez, M Meluzá Martín, R Almaleh, G Youssef, K Sorour, S Abebe, D Mekonnen, C Fekadu, D Yadeta, S Dupuis-Girod, L Delagrange, M Richardson, L Ghesquiere, O Domanski, M Gonzalez Estevez, Y Ould Hamoud, S Gautier, L Marsili, L Bal-Theoleyre, S Palazzolo, M Ladouceur, G Jondeau, A Bourgeois Moine, L Eliaou, O Milleron, M Tchitchinadze, Y Dulac, C Karsenty, N Souletie, F Bajanca, C Rickers, S Blankenberg, C Sinning, C Magnussen, E Zengin, G Mueller, R Schnabel, Y Von Kodolitsch, R Kozlik-Feldmann, H Baumgartner, R Schmidt, A Hellige, A Rietkötter, M Spartalis, A A Frogoudaki, A Arvanitaki, A Baroutidou, G Giannakoulas, C Karvounis, J P Gnanaraj, A P Steaphen, T Ethirajan, K Kannan, V Subramanian, A Surendran, J Gnanasekaran, V Natarajalingam, S Balasubramani, H Ali Farhan, I F Yaseen, E Mariucci, C Ciuca, F Marchi, G Benedetti, M Baroni, P Festa, A Parlanti, G Scognamiglio, F Fusco, B Sarubbi, M Merlo, B D'Agata Mottolese, C Carriere, G Sinagra, M Bobbo, F Ramani, F M Comoglio, R Bordese, A Pagano, N Montali, V Donvito, C A Remolif, F Petey, B Bouma, S Chamuleau, D Robbers-Visser, T Konings, H Dronkert, D Segers, R Van Kimmenade, H Van Der Zwaan, G Tjalling Sieswerda, A Evers, T Schaap, K Bano, H Yasmeen, K Amir, N Patel, P Akhter, R Khan, A Shakeel, S Mahar, S Habib, M Lelonek, P Hoffman, M Lipczynska, L De Sousa, V Ferreira, T Mano, M Selas, R Cruz Ferreira, E Shlyakhto, O Irtyuga, G Sefieva, K Malikov, T Pervunina, U Shadrina, A Kinsara, D Galzerano, H Al Sergani, W Kurdi, N Kholaif, O Vriz, A Alhamshari, A Alsaigh, O Ahmad, S Alzaher, B Alamro, K Sliwa, F Jakoet-Bassier, L Galian-Gay, A Pijuan-Domenech, B Miranda-Barrio, B Gordon, E Furenäs, J Hlebowicz, F Wedlund, E Nagy, E Mattsson, M Majczuk Sennstrom, P Sörensson, C Christersson, A Lutvica, B Jönelid, T Achter, K Junus, H Gärdesten Wall, M Andreasson, D Tobler, J Bouchardy, F Brand, C Blanche, J Bouchardy, T Rutz, F Brand, U Canpolat, Y Z Sener, N Ozer, E Ayduk Gövdeli, Z Bugra, B Umman, P Karaca Özer, D Baykiz, D Mutlu, H Yalman, B Kilickiran Avci, S Catirli Enar, O Batukan Esen, D Oksen, V Lazoryshynets, S Siromakha, Y Davydova, A Limanska, I Zinovchyk, V Kravchenko, B Kravchuk, O Kravets, N Volkova, O Mazur, O Beregovyi, B T Salih, W A R Al Mahmeed, S Wani, F S Mohamed Farook, G Al Mansoori, S Prakash, R Afifi, D Milewicz, A Cecchi, G Wells, D Sparks, W Wagner, C Bigelow, L Colicchia, T Jentink, M Loichinger, R Saxena, W Wunderlich, C Longtin, P Klopper, R Gobar, J Chou, K Campbell, R Elder, D Halpern, A Hausvater, H Reynolds, N Bhalla, A Small, J Feinberg, P Panday, J Awerbach, J Porche, S Stack, L McGrath, A Khan, E Pare, P Woods, C Broberg, K Gibbins, K Brookfield, M Al-Sadawi, A Cove, N Mann

  • September 8, 2025

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