| Abstrakt: |
Introduction:Estimates of maternal and fetal risks during pregnancy with significant valvular heart disease (VHD) are highly variable in the literature due to small sample sizes in each individual study. However, precise estimates are crucial for counseling and managing these patients.Objective:To perform a systematic review and meta-analysis of maternal/fetal outcomes in pregnant women with moderate/severe native VHD from medium/higher Human Development Index countries.Methods:Medline, Embase, and Cochrane database were searched (1985-January 2019) to identify studies reporting pregnancy outcomes in women with moderate/severe VHD. The primary maternal outcome was maternal mortality. The primary fetal/neonatal outcome was stillbirth and neonatal death. Pooled incidences and 95% CI of maternal/fetal outcomes using random-effects models could only be calculated from studies involving mitral stenosis (MS) or aortic stenosis (AS).Results:Twelve studies and 646 pregnancies were included in the meta-analysis. Pregnant women with severe MS had mortality rates of 3% (0-6%), pulmonary edema of 37% (23-51%) and new/recurrent arrhythmias of 16% (1-25%). They also had stillbirth, neonatal death and preterm birth rates of 4% (1-4%), 2% (0-4%), and 18% (7-29%), respectively. Women with moderate MS had mortality rates of 1% (0-2%), pulmonary edema of 18% (0-26%), new/recurrent arrhythmias of 5% (1-9%), stillbirth of 2% (1-4%) and preterm birth (10%; 2-17%). Pregnant women with severe AS had a risk of mortality of 2% (0-5%), pulmonary edema of 9% (2-15%), and new/recurrent arrhythmias of 4% (0-7%). In women with severe AS, stillbirth, neonatal death and preterm birth rates were 2% (0-5%), 3% (0-6%) and 14% (4-24%), respectively. No maternal/neonatal deaths were reported in moderate AS, however women experienced pulmonary edema (8%, 0-20%), new/recurrent arrhythmias (2%, 0-5%), and preterm birth (13%, 6-20%).Conclusions:Women with moderate/severe MS and AS are at risk for adverse maternal and fetal/neonatal outcomes. They should receive preconception counseling and pregnancy care by teams with pregnancy and heart disease experience. |
