Methods:

All patients were seen in a tertiary cardiology aortopathy clinic. Patients were included if they fulfilled Ghent criteria for a diagnosis of Marfan syndrome either with or without confirmatory genetic testing, were a female 18 years or older, had attained final height, and had had a clinic visit within the past 18 months. Subjects were grouped as having had a previously documented pregnancy (yes, no). Women followed prospectively had a confirmed diagnosis of Marfan syndrome prior to pregnancy, underwent echocardiography at a minimum of once within the 12 months prior to pregnancy, at 12-16 weeks’ gestation, 24-26 weeks’ gestation, 35-39 weeks’ gestation, 4-16 weeks postpartum, and then annually per clinical protocol. Nulliparous females and females not receiving prospective cardiac care during pregnancy had a minimum of annual echocardiograms from the time of diagnosis until last follow-up. The primary outcomes were a composite adverse outcome (defined as death, aortic dissection, severe symptomatic aortic insufficiency, or need for urgent surgery), and the need for elective aortic surgery.