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Perinatal outcomes in pregnancies complicated by maternal cardiomyopathy: A systematic review and meta-analysis

Published:September 20, 2022DOI:https://doi.org/10.1016/j.ajog.2022.09.025
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      ABSTRACT

      Objective

      To systematically assess perinatal outcomes of pregnancies complicated by maternal cardiomyopathy.

      Data sources

      PubMed, Ovid EMBASE, Ovid Medline, Cochrane Library and Clinicaltrials.gov were systematically searched from inception to August 25th 2022.

      Study eligibility criteria

      Observational cohort, case-control, and case-cohort studies in human populations were included if they reported pre-defined perinatal outcomes in pregnant women with cardiomyopathy (any sub-type) and an appropriate control population (either pregnant women with no known cardiac disease or pregnant women with non-cardiomyopathy cardiac disease).

      Study appraisal and synthesis methods

      Two reviewers independently assessed articles for eligibility and risk of bias, and conflicts were resolved by a third reviewer. Data were extracted and synthesised according to PRISMA/MOOSE guidelines.

      Results

      13 studies (n=2,291,024) pregnancies were eligible for inclusion. Perinatal death was more likely in neonates born to women with cardiomyopathy compared to (i) women with no cardiac disease (stillbirth: OR 20.82, 95%CI 6.68-64.95, I2=NA%, p<0.00001; neonatal mortality: OR 6.75, 95%CI 3.54-12.89, I2=0%, p<0.00001) and (ii) women with other forms of cardiac disease (stillbirth: OR 3.75, 95%CI 1.86-7.59, I2=0%, p=0.0002; neonatal mortality: OR 2.42, 95%CI 1.39-4.21, I2=0%, p=0.002). Compared to other forms of cardiac disease, pregnancies affected by maternal cardiomyopathy were significantly more likely to result in preterm birth (OR 2.21, 95%CI 1.31-3.73, I2=77%, p=0.003) and small-for-gestational age neonates (OR 2.97, 95%CI 2.38-3.70, I2=47%, p<0.00001), both major causes of short and long-term morbidity.

      Conclusions

      There is an increased likelihood of adverse perinatal outcomes in pregnancies affected by maternal cardiomyopathy compared with both non-cardiomyopathy cardiac disease and no cardiac disease. Women with cardiomyopathy who embark on pregnancy should receive detailed counselling regarding these risks and have their pregnancies managed by experienced multidisciplinary teams that can provide close fetal monitoring and neonatology expertise.

      Keywords

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